Protein, Blood, Total and Fractions

Synonym/acronym: TP, SPEP (fractions include albumin, α₁-globulin, α₂-globulin, β-globulin, and γ-globulin).

Common use

To assess nutritional status related to various disease and conditions such as dehydration, burns, and malabsorption.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube.

Normal findings

(Method: Spectrophotometry for total protein, electrophoresis for protein fractions) Total Protein

Age	Conventional Units	SI Units (Conventional Units × 10)
Newborn–5 days	3.8–6.2 g/dL	38–62 g/L
1–3 yr	5.9–7 g/dL	59–70 g/L
4–6 yr	5.9–7.8 g/dL	59–78 g/L
7–9 yr	6.2–8.1 g/dL	62–81 g/L
10–19 yr	6.3–8.6 g/dL	63–86 g/L
Adult	6–8 g/dL	60–80 g/L

Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms. Protein Fractions

	Conventional Units	SI Units (Conventional Units × 10)
Albumin	3.4–4.8 g/dL	34–48 g/L
α₁-Globulin	0.2–0.4 g/dL	2–4 g/L
α₂-Globulin	0.4–0.8 g/dL	4–8 g/L
β-Globulin	0.5–1 g/dL	5–10 g/L
γ-Globulin	0.6–1.2 g/dL	6–12 g/L

Values may be slightly decreased in older adults due to insufficient intake or the effects of medications and the presence of multiple chronic or acute diseases with or without muted symptoms.

Description

Protein is essential to all physiological functions. Proteins consist of amino acids, the building blocks of blood and body tissues. Protein is also required for the regulation of metabolic processes, immunity, and proper water balance. Total protein includes albumin and globulins. Albumin, the protein present in the highest concentrations, is the main transport protein in the body. Albumin also significantly affects plasma oncotic pressure, which regulates the distribution of body fluid between blood vessels, tissues, and cells. α₁-Globulin includes α₁-antitrypsin, α₁-fetoprotein, α₁-acidglycoprotein, α₁-antichymotrypsin, inter-α₁-trypsin inhibitor, high-density lipoproteins, and group-specific component (vitamin D–binding protein). α₂-Globulin includes haptoglobin, ceruloplasmin, and α₂-macroglobulin. β-Globulin includes transferrin, hemopexin, very-low-density lipoproteins, low-density lipoproteins, β₂-microglobulin, fibrinogen, complement, and C-reactive protein. γ-Globulin includes immunoglobulin (Ig) G, IgA, IgM, IgD, and IgE. After an acute infection or trauma, levels of many of the liver-derived proteins increase, whereas albumin level decreases; these conditions may not reflect an abnormal total protein determination.

This procedure is contraindicated for

N/A

Indications

Evaluation of edema, as seen in patients with low total protein and low albumin levels
Evaluation of nutritional status

Potential diagnosis

Increased in

α₁-Globulin proteins in acute and chronic inflammatory diseases
α₂-Globulin proteins occasionally in diabetes, pancreatitis, and hemolysis
β-Globulin proteins in hyperlipoproteinemias and monoclonal gammopathies
γ-Globulin proteins in chronic liver diseases, chronic infections, autoimmune disorders, hepatitis, cirrhosis, and lymphoproliferative disorders
Total protein:
- Dehydration (related to hemoconcentration)
- Monoclonal and polyclonal gammopathies (related to excessive γ-globulin protein synthesis)
- Myeloma (related to excessive γ-globulin protein synthesis)
- Sarcoidosis (related to excessive γ-globulin protein synthesis)
- Some types of chronic liver disease
- Tropical diseases (e.g., leprosy) (related to inflammatory reaction)
- Waldenström’s macroglobulinemia (related to excessive γ-globulin protein synthesis)

Decreased in

₁

₂

Administration of IV fluids (related to hemodilution)
Burns (related to fluid retention, loss of albumin from chronic open burns)
Chronic alcoholism (related to insufficient dietary intake; diminished protein synthesis by damaged liver)
Chronic ulcerative colitis (related to poor intestinal absorption)
Cirrhosis (related to damaged liver, which cannot synthesize adequate amount of protein)
Crohn’s disease (related to poor intestinal absorption)
Glomerulonephritis (related to alteration in permeability that results in excessive loss by kidneys)
Heart failure (related to fluid retention)
Hyperthyroidism (possibly related to increased metabolism and corresponding protein synthesis)
Malabsorption (related to insufficient intestinal absorption)
Malnutrition (related to insufficient intake)
Neoplasms
Nephrotic syndrome (related to alteration in permeability that results in excessive loss by kidneys)
Pregnancy (related to fluid retention, dietary insufficiency, increased demands of growing fetus)
Prolonged immobilization (related to fluid retention)
Protein-losing enteropathies (related to excessive loss)
Severe skin disease
Starvation (related to insufficient intake)

Critical findings

N/A

Interfering factors

Drugs that may increase protein levels include amino acids (if given IV), anabolic steroids, angiotensin, anticonvulsants, corticosteroids, corticotropin, furosemide, insulin, isotretinoin, levonorgestrel, oral contraceptives, progesterone, radiographic agents, and thyroid agents.
Drugs and substances that may decrease protein levels include acetylsalicylic acid, arginine, benzene, carvedilol, citrates, floxuridine, laxatives, mercury compounds, oral contraceptives, pentastarch, phosgene, pyrazinamide, rifampin, trimethadione, and valproic acid.
Values are significantly lower (5% to 10%) in recumbent patients.
Hemolysis can falsely elevate results.
Venous stasis can falsely elevate results; the tourniquet should not be left on the arm for longer than 60 sec.

Nursing Implications and Procedure

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist in assessing nutritional status related to disease process.
Obtain a history of the patient’s complaints, including a list of known allergens especially allergies or sensitivities to latex.
Obtain a history of the patient’s gastrointestinal, hepatobiliary, and immune systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Nutritional Considerations: Educate the patient, as appropriate, that good dietary sources of complete protein (containing all eight essential amino acids) include meat, fish, eggs, and dairy products and that good sources of incomplete protein (lacking one or more of the eight essential amino acids) include grains, nuts, legumes, vegetables, and seeds.
Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

Related tests include albumin, ALP, ACE, anion gap, AST, biopsy liver, biopsy lung, calcium, carbon dioxide, chloride, CBC WBC count and differential, cryoglobulin, fecal analysis, fecal fat, gallium scan, GGT, IgA, IgG, IgM, IFE, liver and spleen scan, magnesium, mediastinoscopy,β ₂-microglobulin, osmolality, protein urine total and fractions, PFT, radiography bone, RF, sodium, TSH, thyroxine, and UA.
Refer to the Gastrointestinal, Hepatobiliary, and Immune systems tables at the end of the book for related tests by body system.