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Total Protein and A/G Ratio

Total Protein and A/G Ratio

Also known as: TP; Albumin/Globulin ratio

Formal name: Total Protein; Albumin/Globulin ratio

Related tests: Albumin; Liver panel; Protein electrophoresis

At a Glance

Why Get Tested?

As part of a general health checkup, to determine your nutritional status or to screen for certain liver and kidney disorders as well as other diseases

When to Get Tested?

When you have a routine physical exam or if you experience unexpected weight loss or fatigue or if your doctor thinks that you have symptoms of a liver or kidney disorder

Sample Required?

A blood sample drawn from a vein in your arm or by fingerstick (adults and children) or heelstick (newborns)

Test Preparation Needed?


The Test Sample

What is being tested?

Proteins are important building blocks of all cells and tissues; they are important for body growth, development, and health. They form the structural part of most organs and make up enzymes and hormones that regulate body functions. This test measures the total amount of the various types of proteins in the plasma portion of your blood.

There are two classes of proteins, albumin and globulin, found in the blood. Albumin is a carrier of many small molecules, but its main purpose is to keep fluid from leaking out of blood vessels through osmotic pressure. Globulin proteins include enzymes, antibodies, and more than 500 other proteins. The ratio of albumin to globulin (A/G ratio) is calculated from values obtained by direct measurement of total protein and albumin. It represents the relative amounts of albumin and globulins.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in your arm or by a fingerstick (for children and adults) or heelstick (for newborns).

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

How is it used?

Total protein measurements can reflect nutritional status and may be used to screen for and help diagnose kidney disease, liver disease, and many other conditions. Sometimes conditions are first detected with routine testing before symptoms have begun to appear. If total protein is abnormal, further tests must be performed to identify which specific protein is abnormally low or high so that a specific diagnosis can be made.

When is it ordered?

A total protein test is one component of a Comprehensive Metabolic Panel (CMP) that is often ordered as part of a routine health checkup. Total protein may also be ordered to provide general information about your nutritional status, such as when you have undergone a recent weight loss. It can be ordered along with several other tests to provide information if you have symptoms that suggest a liver or kidney disorder or to investigate the cause of abnormal pooling of fluid in tissue (edema).

What does the test result mean?

Results of a total protein test will give your doctor information on your general health status with regard to your nutrition and/or conditions involving major organs, such as the kidney and liver. However, if results are abnormal, further testing is usually required to help diagnose the disease affecting protein levels in the blood.

Low total protein levels can suggest a liver disorder, a kidney disorder, or a disorder in which protein is not digested or absorbed properly. Low levels may be seen in severe malnutrition and with conditions that cause malabsorption, such as Celiac disease or inflammatory bowel disease (IBD).

High total protein levels may be seen with chronic inflammation or infections such as viral hepatitis or HIV. They may be caused by bone marrow disorders such as multiple myeloma.

Some laboratories also report the calculated ratio of albumin to globulins, termed the A/G ratio. Normally, there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease states affect the relative changes in albumin and globulins in different ways, this may provide a clue to your doctor as to the cause of the change in protein levels. A low A/G ratio may reflect overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases, or underproduction of albumin, such as occurs with cirrhosis, or selective loss of albumin from the circulation, as occurs with kidney disease (nephrotic syndrome). A high A/G ratio suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias. More specific tests, such as albumin, liver enzyme tests, and serum protein electrophoresis must be performed to make an accurate diagnosis.

Is there anything else I should know?

Prolonged application of a tourniquet during blood collection can result in a blood sample that has a higher protein concentration than the rest of the circulation. This will mean that the test result for total protein will be falsely elevated (higher than the actual concentration in the circulation).

Drugs that may decrease protein levels include estrogens and oral contraceptives.

Common Questions

Will a high protein diet raise my total protein level?

No, increasing your intake of protein will not increase your total protein test result.

What type of nutrition is recommended for optimal protein levels?

A well-balanced diet that follows the recommendations of the United States Department of Agriculture is summarized by the Food Pyramid.

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