About half of the calcium in the blood is bound to proteins (mainly albumin), while the other half — ionized calcium — is free and biologically active. Ionized calcium provides the most accurate measure of calcium status because it isn't affected by albumin variations the way total calcium is.
This test is most useful in critically ill patients, those with abnormal albumin (such as in liver or kidney disease), during dialysis or large transfusions, and when results from total calcium are difficult to interpret. It is also used to evaluate symptoms suggesting calcium imbalance such as tetany or arrhythmias. Sample handling matters — proper anaerobic collection is needed for accurate results.
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