720 North Tustin Avenue
Suite 104
Santa Ana, CA 92705-3606
Phone: (714) 565-1032
Fax: (714) 565-1035

Jeremy E. Kaslow, MD, FACP, FACAAI Physician and Surgeon
Board Certified Internal Medicine

NOTICE TO CONSUMERS
Medical Doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

SERUM PROTEINS

Proteins are the most abundant compounds in your serum (the rest of your blood when you remove all the cells). Amino acids are the building blocks of all proteins. In turn proteins are the building blocks of all cells and body tissues. They are the basic components of enzymes, many hormones, antibodies and clotting agents. Proteins act as transport substances for hormones, vitamins, minerals, lipids and other materials. In addition, proteins help balance the osmotic pressure of the blood and tissue. Osmotic pressure is part of what keeps water inside a particular compartment of your body. Proteins play a major role in maintaining the delicate acid-alkaline balance of your blood. Finally, serum proteins serve as a reserve source of energy for your tissues and muscle when you are not ingesting an adequate amount.

The major measured serum proteins are divided into two groups, albumin and globulins. There are four major types of globulins, each with specific properties and actions. A typical blood panel will provide four different measurements - the total protein, albumin, globulins, and the albumin globulin ratio.

Total Protein

Because the total protein represents the sum of albumin and globulins, it is more important to know which protein fraction is high or low than what is the total protein. Ideally, the total protein will be approximately 7.5 g/dl.

Optimal Range: 7.2-8.0 g/100ml

Total protein may be elevated due to:

  • Chronic infection (including tuberculosis)
  • Adrenal cortical hypofunction
  • Liver dysfunction
  • Collagen Vascular Disease (Rheumatoid Arthritis, Systemic Lupus, Scleroderma)
  • Hypersensitivity States
  • Sarcoidosis
  • Dehydration (diabetic acidosis, chronic diarrhea, etc.)
  • Respiratory distress
  • Hemolysis
  • Cryoglobulinemia
  • Alcoholism
  • Leukemia

Total protein may be decreased due to:

  • Malnutrition and malabsorption (insufficient intake and/or digestion of proteins)
  • Liver disease (insufficient production of proteins)
  • Diarrhea (loss of protein through the GI tract)
  • Severe burns (loss of protein through the skin)
  • Hormone Imbalances that favor breakdown of tissue
  • Loss through the urine in severe kidney disease (proteinuria)
  • Low albumin (see "albumin")
  • Low globulins (see "globulins")
  • Pregnancy (dilution of protein due to extra fluid held in the vascular system)

Albumin

Albumin is synthesized by the liver using dietary protein. Its presence in the plasma creates an osmotic force that maintains fluid volume within the vascular space. A very strong predictor of health; low albumin is a sign of poor health and a predictor of a bad outcome.

Optimal Range: 4.5-5.0 g/100ml

Albumin levels may be elevated in:

  • Dehydration - actual
  • Congestive heart failure
  • Poor protein utilization
  • Glucocorticoid excess (can result from taking medications with cortisone effect, the adrenal gland overproducing cortisol, or a tumor that produces extra cortisol like compounds)
  • Congenital

Albumin levels may be decreased in:

  • Dehydration
  • Hypothyroidism
  • Chronic debilitating diseases (ex: RA)
  • Malnutrition - Protein deficiency
  • Dilution by excess H2O (drinking too much water, which is termed “polydipsia,” or excess administration of IV fluids)
  • Kidney losses (Nephrotic Syndrome)
  • Protein losing-enteropathy (protein is lost from the gastrointestinal tract during diarrhea)
  • Skin losses (burns, exfoliative dermatitis)
  • Liver dysfunction (the body is not synthesizing enough albumin and indicates very poor liver function)
  • Insufficient anabolic hormones such as Growth Hormone, DHEA, testosterone, etc.

GLOBULINS, Total serum

Globulins are proteins that include gamma globulins (antibodies) and a variety of enzymes and carrier/transport proteins. The specific profile of the globulins is determined by protein electrophoresis (SPEP), which separates the proteins according to size and charge. There are four major groups that can be identified: gamma globulins, beta globulins, alpha-2 globulins, and alpha-1 globulins. Once the abnormal group has been identified, further studies can determine the specific protein excess or deficit. Since the gamma fraction usually makes up the largest portion of the globulins, antibody deficiency should always come to mind when the globulin level is low. Antibodies are produced by mature B lymphocytes called plasma cells, while most of the other proteins in the alpha and beta fractions are made in the liver.

Optimal Range: 2.3-2.8 g/dL

Optimal Range (Alpha Globulin): 0.2-0.3 g/L

Optimal Range (Beta Globulin): 0.7-1.0 g/L

The globulin level may be elevated in:

  • Chronic infections (parasites, some cases of viral and bacterial infection)
  • Liver disease (biliary cirrhosis, obstructive jaundice)
  • Carcinoid syndrome
  • Rheumatoid arthritis
  • Ulcerative colitis
  • Multiple myelomas, leukemias, Waldenstrom's macroglobulinemia
  • Autoimmunity (Systemic lupus, collagen diseases
  • Kidney dysfunction (Nephrosis)

The serum globulin level may be decreased in:

  • Nephrosis (A Condition in which the kidney does not filter the protein from the blood and it leaks into the urine)
  • Alpha-1 Antitrypsin Deficiency (Emphysema)
  • Acute hemolytic anemia
  • Liver dysfunction
  • Hypogammaglobulinemia/Agammaglobulinemia

 

A/G (ALBUMIN/GLOBULIN) RATIO

The liver can function adequately on 20% of liver tissue, thus early diagnosis by lab methods is difficult. A reversed A/G Ratio may be a helpful indicator. With severe liver cell damage, the prolonged prothrombin time will not change with ingestion of Vitamin K. The proper albumin to globulin ratio is 2:1. When <1.7, there is may be a need for increasing stomach acidity. When >3.5 there may be a need for stomach acidity and pepsin.

Optimal Range: 1.7-2.2

The AG ratio may be elevated in:

  • Hypothyroidism
  • High protein/high carbohydrate diet with poor nitrogen retention
  • Hypogammaglobulinemia (low globulin)
  • Glucocorticoid excess (can be from taking medications with cortisone effect, the adrenal gland overproducing cortisol, or a tumor that produces extra cortisol like compounds, low globulin)

The AG ratio may be decreased in:

  • Liver dysfunction
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