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Protein (Total), Serum


Definition


  • Total serum protein is the sum of the concentration of the circulating proteins. A total serum protein test is a blood test that measures the amounts of total protein, albumin, and globulin in the blood. The amounts of albumin and globulin also are compared (albumin/globulin ratio). Normally, there is a little more albumin than globulin, and the ratio is >1. A ratio <1 or much >1 can give clues about problems in the body.
  • Normal range:
    • 0 " “7 days: 4.6 " “7.0 g/dL
    • 7 days " “1 year: 4.4 " “7.5 g/dL
    • 1 " “3 years: 5.5 " “7.5 g/dL
    • 3 years to adult: 6.0 " “8.0 g/dL

Use


  • Diagnosis and treatment of diseases involving the liver, kidney, or bone marrow, as well as other metabolic or nutritional disorders
  • Screening for nutritional deficiencies and gammopathies

Interpretation


Increased In


  • Hypergammaglobulinemias (monoclonal or polyclonal; see following sections)
  • Hypovolemic states

Decreased In


  • Nutritional deficiency (e.g., malabsorption, Kwashiorkor, marasmus)
  • Decreased or ineffective protein synthesis (e.g., severe liver disease, agammaglobulinemia)
  • Increased loss
    • Renal (e.g., nephrotic syndrome)
    • GI disease (e.g., protein-losing enteropathies, surgical resection)
    • Severe skin disease (e.g., burns, pemphigus vulgaris, eczema)
    • Blood loss, plasmapheresis
  • Increased catabolism (e.g., fever, inflammation, hyperthyroidism, malignancy, chronic diseases)
  • Dilutional (e.g., IV fluids, SIADH, water intoxication)
  • Third trimester of pregnancy

Limitations


  • Falsely elevated proteins (pseudohyperproteinemia) can be caused by hemoconcentration due to dehydration or sample desiccation.
  • Upright posture for several hours after rising increases total proteins and several other analytes
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