• Protein, Total (Serum)
• Albumin-Globulin ratio
• A/G ratio
• Blood Protein Test
• Globulin Test
• Globulin
• Serum Protein Test
• TP

• Red or tiger top tube
• 5-7 mL of venous blood

Additional information

• The tourniquet should not be left on the arm for longer than 60 seconds
• Handle sample gently to prevent hemolysis
• Send the sample to lab within 4 hrs

• Total protein test is the quantitative analysis of total amount of circulating protein in the blood
• Proteins are one of the most abundant components of the serum consisting of amino acids, the building blocks of blood and body tissues.
• Proteins are the basic components of enzymes, hormones, antibodies, and clotting factors
• Serum total protein consists albumin and globulin
• Albumin is the major component of total proteins, synthesized mainly in the liver, and maintains colloidal osmotic pressure in both the intravascular and extravascular spaces
• Globulins are made of four major fractions which include:
• ₁ globulins ( ₁-antitrypsin, ₁-fetoprotein, ₁-acid glycoprotein, ₁-antichymotrypsin, inter-a₁-trypsin inhibitor, high-density lipoproteins, and vitamin D-binding protein)
• ₂ globulins (haptoglobin, ceruloplasmin, and ₂-macroglobulin)
• Beta globulins (transferrin, hemopexin, very-low-density lipoproteins, low-density lipoproteins, ₂-microglobulin, fibrinogen, complement, and C-reactive protein)
• Gamma globulins (IgG, IgA, IgM, IgD, and IgE)

[For quantitative distribution of these fractions, protein electrophoresis (SPEP) may be performed]
• Normally, glomerular membrane allows only proteins of low molecular weight to enter the filtrate and most of these proteins are reabsorbed by the renal tubules, resulting in very little excretion of protein in the urine

• The clinical utility of the serum total protein test includes:
• Aids in the diagnosis of:
• Gastrointestinal disorders
• Hepatic disease
• Neoplastic diseases
• Renal disorders
• Evaluation of edema or other abnormal fluid collection such as with ascites, congestive heart failure, peripheral edema, or pulmonary edema
• Evaluation of protein loss with burns, gastrointestinal or renal losses
• Evaluation of nutritional status (malnutrition)
• Evaluation of conditions such as multiple myeloma or Waldenstrom's macroglobulinemia
• For the routine chemistry profile, total globulins are calculated as follows:

Total Protein - Albumin = Globulins
• The A/G ratio is of significance in conditions such as injuries and infections, where globulin levels are increased and albumin levels are decreased, though total protein levels remains unchanged

Additional information

• Related laboratory tests include:
• Albumin (Serum)
• Blood and urine immunofixation electrophoresis
• Complete blood count
• Immunoglobulins such as IgA, IgG, IgM
• Serum protein electrophoresis (SPEP)
• Urine protein
• Urine protein electrophoresis

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

	Conv. units (g/dL)	SI units (g/L)
Total Protein
Adult	6.0-8.5	60-85
5-18 yrs	6.0-8.5	60-85
5 yrs	5.5-7.0	55-70
Newborn	4.6-7.6	46-76
Albumin
Adult	3.5-5.0	35-50
5-18 yrs	3.0-5.6	30-56
5 yrs	2.8-4.4	28-44
Globulins
Total
1-globulin	0.1-0.4	1-4
2-globulin	0.4-1.0	4-10
-globulin	0.5–1.3	5-13
Gamma-globulins	0.6–1.6	6-16

See Albumin (Serum) Test

Conditions associated with elevated total proteins (hyperproteinemia) include:

• Chronic infections such as tuberculosis, leishmaniasis
• Chronic inflammatory disease such as Laënnec's cirrhosis (early-stage)
• Adrenal cortical hyperfunction (Cushing's disease)
• Collagen disorders
• Rheumatoid arthritis (RA)
• Scleroderma
• Systemic lupus erythematosus (SLE)
• Cryoglobulinemia
• Cholelithiasis
• Dehydration and hemoconcentration
• Diarrhea
• Poor kidney function
• Vomiting
• Diabetic ketoacidosis
• Heavy chain disease
• Hemolysis
• Hypersensitivity states
• Liver diseases
• Monoclonal gammopathies
• Multiple myeloma
• Waldenström's macroglobulinemia
• Monocytic leukemia
• Pheochromocytoma
• Sarcoidosis
• Alcoholism
• Exercise
• Drugs and substances
• Amino acids (IV)
• Anabolic steroids
• Androgens
• Angiotensin
• Anticonvulsants
• Carbenicillin
• Corticosteroids
• Corticotropin
• Digitalis
• Epinephrine
• Furosemide
• Growth hormone
• Insulin
• Isotretinoin
• Progesterone
• Radiographic agents
• Thyroid agents

Conditions associated with elevated globulins include:

• Collagen vascular diseases
• Diabetes mellitus
• Hodgkin's disease
• Multiple myeloma
• Rheumatoid arthritis (RA)
• Subacute bacterial endocarditis (SBE)
• Syphilis (Chronic)
• Systemic lupus erythematosus (SLE)
• Tuberculosis (TB)

Conditions associated with elevated A/G ratio include:

• Hypothyroidism
• High protein/high carbohydrate diet with poor nitrogen retention
• Hypogammaglobulinemia
• Low globulin
• Glucocorticoid excess
• Adrenal gland overproducing cortisol
• Extra cortisol like substances produced by a tumor
• Drugs such as cortisone or derivitives

Factors causing false positive results include:

• Venous stasis due to tourniquet left on the arm for prolonged time
• Hemolysis
• Administration of contrast agent such as sulfobromophthalein

See Albumin (Serum) Test

Conditions associated with decreased total proteins (hypoproteinemia) include:

• Agammaglobulinemia
• Blood dyscrasias
• Burns (Severe)
• Diabetes mellitus (poorly controlled)
• Essential hypertension
• Gastrointestinal diseases
• Crohn's disease
• Gastritis
• Protein losing-enteropathy
• Ulcerative colitis
• Whipple's disease
• Gastrointestinal carcinoma (stomach, colon, rectum, etc.)
• Heart failure
• Hepatic disorders
• Cirrhosis
• Hepatic failure of any cause
• Hepatolenticular degeneration
• Toxic hepatitis
• Hemorrhage
• Hodgkin's disease
• Hypothyroidism
• Insufficient nutritional intake
• Malabsorption
• Malnutrition
• Starvation
• Renal disease
• Nephrosis
• Nephrotic syndrome
• Glomerulonephritis
• Chronic renal failure
• Shock
• Pre-eclampsia and eclampsia
• Pregnancy – last trimester
• Prolonged bed rest as in hospital illness or chronic illness
• Drugs and substances
• Acetylsalicylic acid
• Arginine
• Benzene
• Carbon tetrachloride
• Carvedilol
• Citrates
• Floxuridine
• Laxatives
• Levonorgestrol
• Mercury compounds
• Oral contraceptives
• Pentastarch
• Phosgene
• Pyrazinamide
• Rifampin
• Trimethadione
• Valproic acid

Conditions associated with decreased globulin levels include:

• ₁-antitrypsine deficiency
• Blood dyscrasias
• Burns (Severe)
• Diabetes mellitus (poorly controlled)
• Essential hypertension
• Gastrointestinal disease
• Heart failure
• Hemorrhage
• Hepatic dysfunction
• Hodgkin's disease
• Hyperthyroidism
• Malabsorption
• Nephrosis
• Poisoning (Benzene, carbon tetrachloride)
• Surgical and traumatic shock
• Toxemia of pregnancy

The AG ratio may be decreased in liver dysfunction

See Albumin (Serum) Test

• Corbett BA et al. A proteomic study of serum from children with autism showing differential expression of apolipoproteins and complement proteins. Mol Psychiatry. 2006 Dec 26; [Epub ahead of print]
• Goksel K et al. Albuminuria and tubular markers in juvenile idiopathic arthritis. Pediatr Nephrol. 2005 Feb;20(2):154-8. Epub 2004 Dec 15.
• Hortin GL et al. Bound Homocysteine, Cysteine, and Cysteinylglycine Distribution between Albumin and Globulins. Clin Chem. 2006 Dec;52(12):2258-64. Epub 2006 Oct 26.
• Kalinin NN et al. [Quantitative assessment of protein replacement in therapeutic plasmapheresis] [Article in Russian]. Ter Arkh 2003;75(2):65-8.
• Laboratory Corporation of America. Protein, Total, Serum. [Homepage on the internet]©2003. Last accessed on January 8, 2007. Available at URL: http://www.labcorp.com/datasets/labcorp/html/chapter/mono/pr007800.htm
• LabTestsOnline®. Total Protein and A/G Ratio. [Homepage on the Internet]© 2001-2006. Last reviewed on August 10, 2005. Last accessed on January 8, 2007. Available at URL: http://www.labtestsonline.org/understanding/analytes/tp/glance.html
• MedlinePlus Medical Encyclopedia. Total Protein. [Homepage on the internet]©2005. Last updated on June 1, 2005. Last accessed on January 8, 2007. Available at URL: http://www.nlm.nih.gov/medlineplus/ency/article/003483.htm
• UTMB Laboratory Survival Guide®. PROTEIN, TOTAL, serum or plasma. [Homepage on the Internet]© 2006. Last reviewed in February 2006. Last accessed on January 8, 2007. Available at URL: http://www.utmb.edu/lsg/LabSurvivalGuide/chem/PROTEIN_total.html