Ischaemia-modified albumin (IMA), as measured by the albumin-cobalt binding(ACB) test®, has been cleared by the US Food and Drug administration as abiomarker to exclude the presence of myocardial ischaemia in patients.Although there are a number of published studies detailing the clinicalutility of IMA, data on the biological variation of IMA are still lacking.In this study we determined the analytical and biological variancecomponents of ischaemia-modified albumin, and compared the distribution ofIMA values in our patient population to those provided by the kitmanufacturer. The gene discussed is ALB; the disease is ischemia.