What is the total protein marker?
Total protein is the sum concentration of all individual serum proteins (g/dL). There are many hundreds of different protein species in serum, including straight polypeptides as well as glycosylated and lipid-associated forms.
Since total protein consists mainly of a composite of albumin and globulins, the result is not interpreted in isolation, but rather is interpreted in context of the changes in albumin and globulins (independently and in relation to each other). Albumin generally accounts for about half (~50%) of the total protein concentration in plasma.
What is the total protein test?
The total protein marker measures the total amount of protein in your blood and specifically looks for the amount of albumin and globulin.
The total protein test is performed as part of an bi-annual health checkup. It is usually part of a test panel that is called Comprehensive Metabolic Panel.
The total protein markers may also be ordered if you experience:
- unexplained weight loss
- fatigue
- edema, which is swelling caused by extra fluid in your tissues
- symptoms of kidney or liver disease
Having too many or too few proteins can lead to unexpected weight loss, fatigue, or inflammatory disease. The total protein test can help diagnose liver and kidney diseases, along with other conditions.
What are proteins?
→ Proteins are important building blocks of all cells and tissues.
→ Proteins are necessary for your body’s growth, development, and health.
What are albumin and globulin?
Blood contains albumin and globulin.
→ Albumin proteins keep fluid from leaking out of your blood vessels.
→ Globulin proteins play an important role in your immune system.
Albumin and globulin are two types of protein in your body. The total protein test measures the total amount of albumin and globulin in your body. It’s used as part of your routine health checkup. It may also be used if you have unexpected weight loss, fatigue, or the symptoms of a kidney or liver disease.
Albumin:
Albumin protein accounts for 50% of the total protein found in your blood plasma. It regulates oncotic pressure [= the osmotic pressure generated by large molecules (especially proteins) in solution] in the plasma to prevent water from leaking out of the blood vessels.
Albumin is made mainly in the liver. Albumin also helps carry some medicines and other substances through the blood and is important for tissue growth and healing.
Globulin:
Globulin proteins vary in size, weight, and function. Serum globulin can be separated into several subgroups by serum protein electrophoresis that include α1, α2, β and γ fractions (aka: alpha, beta, and gamma types). They include carrier proteins, enzymes, complement, and immunoglobulins (also called antibodies). Some globulins are made by the liver, while others are made by the immune system. Certain globulins bind with hemoglobin. Other globulins transport metals, such as iron, in the blood and help fight infection.
What is the normal reference range for total protein in serum?
The normal range for total protein is between 6 and 8.3 grams per deciliter (g/dL). This range may vary slightly among laboratories. These ranges are also due to other factors such as:
- age
- gender
- population
- test method
Your total protein measurement may also increase during pregnancy.
If total protein is abnormal, additional tests must be performed to identify which specific protein is low or high before a diagnosis can be made.
What is a urine protein test?
A urine total protein test detects the amounts of protein present in the urine. The kidneys filter albumin and other proteins from the blood so that the urine may contain small amounts of protein. However, problems with the urinary tract, such as chronic kidney disease, can cause large amounts of protein to leak into the urine. Usually, a person’s body eliminates less than 150 milligrams (mg) of total protein and less than 20 mg of albumin through the urine every 24 hours.
Sources/Links:
https://www.nhs.uk/conditions/total-protein-test/
https://www.mountsinai.org/health-library/tests/total-protein
https://medlineplus.gov/ency/article/003483.htm
https://www.ucsfbenioffchildrens.org/medical-tests/003483
References:
Busher JT. Serum Albumin and Globulin. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 101. Available from: https://www.ncbi.nlm.nih.gov/books/NBK204/
Nagra N, Dang S. Protein Losing Enteropathy. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542283/
Bruck E. Laboratory tests in the analysis of states of dehydration. Pediatr Clin North Am. 1971 Feb;18(1):265-83. doi: 10.1016/s0031-3955(16)32538-x. PMID: 25868190.
Low serum total protein levels may suggest any of the following (health) conditions:
- agammaglobulinemia (= an inherited disorder in which a person has very low levels of protective immune system proteins called immunoglobulins. Immunoglobulins are a type of antibody. Low levels of these antibodies make you more likely to get infections.)
- bleeding
- congestive heart failure
- delayed post-surgery recovery
- extensive burns
- inflammatory conditions
- kidney disorder (nephrotic disorder or glomerulonephritis)
- liver disorder/disorder
- malabsorption conditions (celiac disease, inflammatory bowel disease, Crohn's disease, chronic ulcerative colitis)
- malnutrition / starvation
- pregnancy
- receiving intravenous fluids
- chronic alcoholism
- prolonged immobilization
- nephrotic syndromes
- neoplasia
- protein losing enteropathies
- hyperthyroidism
- burns
- severe skin disease
Very low total protein (<4 g/dL) and low albumin cause edema (eg, the nephrotic syndromes).
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High protein in blood (called hyperproteinemia) means you have abnormally high levels of protein in your blood plasma. If your blood protein levels are unusually high, a healthcare provider will order more tests to determine the condition or issue that caused your high blood protein levels.
High serum total protein levels can indicate the following health conditions:
- inflammation or infections, such as viral hepatitis B or C, or HIV
- bone marrow disorders, such as multiple myeloma or Waldenstrom’s disease
- dehydration
- chronic kidney disease
- liver disease (including chronic active hepatitis and cirrhosis)
- tropical diseases (eg, kala-azar, leprosy, and others);
- granulomatous diseases, such as sarcoidosis;
Diseases in which total protein is sometimes high include:
Collagen disease [eg, lupus erythematosus (SLE), and other instances of chronic infection/inflammation].
What are high blood protein symptoms?
High blood protein levels do not cause symptoms. You may learn you have high blood protein if a healthcare provider orders a comprehensive metabolic panel. The results will show your total protein levels, albumin levels and the ratio of albumin to globulins, or A/G ratio. (A normal A/G ratio is 0.8 to 2.0.) If your blood protein levels are unusually high, a healthcare provider may order more tests, such as protein electrophoresis or total immunoglobulin levels.
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Alanine-aminotransferase (ALT, SGPT), Albumin, Serum, Albumin/Globulin (A/G) Ratio, Alkaline Phosphatase (ALP), Aspartate-aminotransferase (AST, SGOT), Bilirubin Total, Blood urea nitrogen (BUN), BUN/Creatinine Ratio, Calcium, Serum, Carbon Dioxide (CO2), Chloride, Serum, Creatinine, Serum, eGFR - Estimated Glomerular Filtration Rate (African Am), eGFR - Estimated Glomerular Filtration Rate (Non-African Am), Globulin, Serum (aka Globulin, Total), Glucose, Intestinal Isoenzymes (Alkaline Phosphatase), Potassium, Serum (Kalium), Sodium, Serum (Natrium), Total Protein, Serum
