PROTEINS

PREPARED BY:
Dayle daniel G. Sorveto, RMT, MSMT
 INTRODUCTION
• Comes from the greek word proteis, meaning “ first rank of
importance”
• Are synthesized in the liver and secreted by the hepatocyte into
the circulation except immunoglobulins
• Most important liver function test
• The are macromolecules composed of polymers of covelently
linked amino acids that are involved in every cellular processes
• Proteins are amphoteric
• Effective blood buffers
• They are very effective antigens due to their mlecular mass,
tyrosine content and their specificity
• They provide 12-20% of the total daily body energy requirement
• Proteins are 50%-70% of the cell’s dry weight
 FUNCTIONS
1. Repair body tissues
2. Important in blood coagulation and
immunologic function
3. For transport of metabolic substances
4. Maintenance of osmotic pressure
5. Maintenance of blood pH
6. Biocatalyst
 FOUR STRUCTURES OF
PROTEINS
1. PRIMARY 2. SECONDARY
STRUCTURE STRUCTURE
• It determines the identity of • It involves the winding of the
protein, molecular structure, polypeptide chain
function binding capacity and • It refers to specific 3-
recognition ability dimensional conformations-
• Any change in the amino acid alpha helix, beta pleated and
composition can significantly bend form
alter the protein
 FOUR STRUCTURES OF
PROTEINS
3. TERTIARY
STRUCTURE
• The folding pattern of the protein
• Responsible for many of the
physical and chemical properties
of the proteins
• It is maintained by electrovalent
linkages, hydrogen bonds,
disulfide bridges, Van der waals
forces and Hydrophobic
interactions
4. QUATERNARY
STRUCTURE
• Is the association of 2 or
more polypeptide chain to
form an functional protein
molecule
• Albumin has no quaternary
structures
• E.q: Hgb, LDH, CK
 CLASSIFICATION OF
PROTEINS
2. CONJUGATED
1.SIMPLE PROTEINS PROTEINS
• Contain peptide chains which • Are composed of a protein
on hydrolysis yield only amino (apoprotein) and a non protein
acids moiety (prosthetic group)
• May be fibrous (fbgn, Tn, • These proteins impart certain
collagen) or globular (hg, characteristics to the proteins
plasma CHONS, enzymes,
peptide hormones) in shape
 CONJUGATED
PROTEINS
1. Metalloproteins  ferritin, ceruloplasmin, hgb,
and flavoproteins
2. Lipoproteins  VLDL, HDL, LDL, Chylomicrons
3. Glycoproteins  haptoglobulin, a1-antitrypsin
4. Mucoproteins or proteoglycans  mucin (higher
CHO content than CHON
5. Nucleoproteins  chromatin (combined with
nucleic acids
“
PLASMA
PROTEINS ”
 1. PREALBUMIN (Transthyretin)
• It migrates ahead of albumin
• It has a half-life of only 2 days
• It is rich in tryptophan and contains 0.5%
carbohydrate
• It has considerable β-pleated sheet conformation
• It serves as transport protein for T4 and retinol
(Vitamin A)- by complexing with retinol-binding
protein
• It is used as landmark to confirm that the
specimen is really CSF- it crosses more easily into
the CSF that other proteins
 1. PREALBUMIN (Transthyretin)

• Increased : alcoholism, chronic renal failure,

steroid treatment
• Decreased: poor nutrition
• Reference value: 18-45 mg/dL
 2. ALBUMIN
• Most abundant protein; Fatty acid transporter;
Calcium and magnesium are the bound ions
• It is synthesized by the liver
• A general transport protein
• It maintains osmotic pressure
• It is an indicator of nutritional status
• It serves as circulating reservoir of amino acids
• it is a sensitive and highly prognostic marker in
cases of cystic fibrosis
• It is a “negative Acute Phase Reactant”
 2. ALBUMIN
• Lowest plasma albumin levels (abrupt/sudden) are
seen in active nephrotic syndrome (edematous)
• Gradual decrease albumin levels are seen in total liver
damage or cirrhosis
• Reference value: 3.5-5.0 g/dL
• Fastest anodal migration
 3. GLOBULIN
• it is a group of proteins consist of α1, α2,β, and γ
fractions
• It is usually measured by substracting the value of
serum albumin from the total protein concentration
• Elevated concentration in early cirrhosis will
balance loss of albumin resulting to normal levels of
total protein
• Measurement: Total Protein – Albumin= Globulin
• Reference value: 2.3-3.5 g/dL(23-35 g/dL)
 APR? Diagnostic Significance Function
1-Antitrypsin YES Inflammation  Major inhibitor of protease activity-
(AAT) Pregnancy prevents self destruction
Emphysematous Pulmonary  Comprises of 90% of the 1-globulin
disease band
Juvenille Hepatic Cirrhosis
1-Fetoprotein Neural tube defect  Post operative marker
(AFP) Anencephaly  Detectable in last trimester
Spina bifida  Tumor marker:
Fetal distress HEPATIC
Ataxia telang GONODAL cancer
Down Syndrome
Trisomy 18
1-Acid YES Cancer  45% CHO + 11% sialic acid
glycoprotein Pneumonia  Transport progesterone
lorosomucoid Rheumatoid Arthritis  Inactivates lipophilic hormones
Cell Proliferation
1-Anti- YES Infection  Serine proteinase with cathepsin G
chymotrypsin Burn  Major PSA transporter
(1-X) AMI  1-X is a vital cpt. Of the amyloid
Alzheimer’s Disease deposits found in Alzheimer’s
Liver Disease disease
 APR? Diagnostic Significance Function
Group specific- Vitamin D transporter
component (GC)

Haptoglobin YES Stressful conditions  Prevents the loss of Hb by transporting

Myoglobinuria free hb to the liver and its constituent
Intravascular hemolysis iron into the urine

Ceruloplasmin YES Infection, Cancer  Copper-binding

Pregnancy  Marker for Wilson’s disease
Wilson’s Disease  Imparts a blue color to protein
Malnutrition  Only protein that has enzymatic activity
Nephritic disease  Vitally important in regulating the ionic
Menke’s kinky-hair syndome state of iron

2- Nephrotic syndrome  Largest major non-immunoglobulin

Macroglobulin Diabetes  Protein in plasma
(AMG) Liver disease  Forms a complex with PSA

C-Reactive YES Acute rheumatoid fever  Cardiac marker

Protein (CRP) MI; RA; Gout  Inflammatory marker
Bacterial and Viral infections
 APR? Diagnostic Function
Significance
β2-Microglobulin Renal Failure  Needed in production of CD8
RA, SLE, HIV  Found on surfaces of nucleated cells
Multiple myeloma
Common cause of
Dialysis-associated
Amyloidosis

Transferrin YES Hemochromatosis  Major cpt. Of β2-globulin fraction

(Siderophilin) (-) IDA  Transports ion
APR Liver disease  Prevents loss of Fe++ through kidney
Nephrotic Syndrome
Malnutrition

Immunoglobulin YES
Lipoprotein
Fibrinogen YES Extensive  Serve as a marker for long-term prognosis of
coagulation cardiovascular disease
Complement YES Inflammation  Participates in immune response
DIC
HA
MISCELLANEOUS
PROTEINS
 1. MYOGLOBIN

- Small heme protein found in skeletal and

cardiac muscle
- Transports and stores oxygen
- Higher affinity for oxygen than Hb
- Approximately 2% of the total muscle
protein
- MW: 18 kDa
- Potential nephrotoxin ( it has to be excreted
when plasma concentration exceeds
reference range)
 1. MYOGLOBIN
Diagnostic Significance:

 Protein marker to diffuse  Marker for monitoring

out ischemic muscle cell
 Marker for chest pain
(angina) and early  Increased:
detection of Acute
myocardial infarction
(AMI)
*** In AMI screening
test:
Onset: 1-3 hours
Peak level: 5-12 hrs
Normalize: 18-30 hrs
the success or failure
of reperfusion
 AMI
 Angina
 Rhabdomyolysis
 Muscle trauma
 Extrenous exercise
 Intramusculat
injection
 Acute Renal Failure
 1. MYOGLOBIN

Methods:

 Measured in SERUM by immunoassay

 Myoglobinuria- it produces a positive dipstick

reaction for occult blood due to
pseudoperoxidase activity

 AMI Value: >100 µg/L

 2. Troponins (Tn)
 Complex of 3 proteins ( regulatory proteins) that
binds to the thin filament of cardiac muscle
 Regulators of actin and myosin

 cTnT and cTnI are nearly absent from normal

serum (many healthy individuals have detectable
levels)
 TnC,TnI, TnT = present in both cardiac and skeletal
muscles
*TnC- binds calcium ions that regulate muscle
contractions.
*TnI and TnT- almost absent in normal serum
(AMI Marker)
Reference Value: <0.1
ng/ml (0.1µg/L)
 2. Troponins (Tn)
Diagnostic Significance:
 MOST important marker for Cardiac Injury (AMI)

• Cardiac Troponins:
• a. Troponin T (TnT)/ Tropomyosin-binding subunit
• valuable tool in the diagnosis of AMI
• assessment of early and late AMI
• useful in monitoring the effectiveness of thrombolytic
therapy in AMI patients
- elevated in Renal disease and muscular dystrophy
- sensitive marker for the diagnosis of unstable
angina (angina at rest)
 2. Troponins (Tn)
• a. Troponin T (TnT)/ Tropomyosin-binding subunit
• *** In AMI:
• Rises within 3-4 hours after onset of myocardial
damage
• Peak level is at 10-24 hours
• Return to normal in 7 days (but may remain elevated
for (10-14 days)
• Serum levels at or above 1.5ng/ml are considered to be
suggestive of AMI.

b. Troponin I (TnI)/ Inhibitory subunit or Actin-binding unit

- GOLD STANDARD for AMI
- only found in myocardium
- highly specific to AMI (not elevated in renal failure patients
and no detectable amount in the skeletal muscles)
 2. Troponins (Tn)
• b. Troponin I (TnI)/ Inhibitory subunit or Actin-
binding unit
- 13 times more abundant in the myocardium than
CK-MB on a weight basis
- Sensitive indicator of Cardiac necrosis
*** In AMI:
• Levels begin to rise 3-6 hours
• Peak in 12-18 hours
• Return to normal in 5-10 days
 Measured in SERUM by immunoassay
Reference values of TnI and TnT as cardiac markers
depend on the antibodies and calibrators used in the
immunoassay
 3. B-type natriuretic peptide (BNP)

 Cardiac Marker

 Increases in response to peptide (BNP)

ventricular systolic and diastolic dysfunction

 Diagnostic of Congestive heart failure

Specimen: HEPARINIZED Plasma (with or

w/o fasing
 4. Cystatin C

 Low molecular protein and a cysteine proteinase inhibitor

 Freely filtered by the glomerulus and completely reabsorbed and
catabolized by the proximal convoluted tubule- produced and
destroyed at a constant rate
 Included in the list of endogenous renal marker owing for its
sensitivity for determining the glomerular filtration rate
 Proposed as an alternate test for serum creatinine and creatinine
clearance test to screen and monitor kidney dysfunction
 Not affected by physiological factors unlike creatinine
 Method: Particle-enhanced immunoturbidimetry,
immunonephelometry
 PROTEINS
in BODY FLUIDS
 1. URINARY PROTEINS
o Majority arise from the blood
o Presence of Urine Albumin is generally considered
abnormal
o >20µg/min (normal albumin excretion rate)
o ≥5mg/dL urine protein - color change on urine
dipstick
• PROTEINURIA (>0.5g/day) – result from either
glomerular or tubular dysfunction
 Types of Proteinuria:
a. Glomerular Proteinuria
 Most common and serious type of abnormal proteinuria
 Often called “Albuminuria”

b. Tubular Proteinuria
 Appearance of low molecular mass proteins due to
defective reabsorption

c. Overload Proteinuria
 Includes Hemoglobinuria, Myoglobinuria & Bence-Jones
Proteinuria
d. Postrenal Proteinuria
 Protein from urinary tract caused by infection, bleeding
or malignancy
 MICROALBUMINURIA
• Early indicator of glomerular dysfunction
• Albumin excretion of 30 ug/mg creatinine to 300ug/mg
creatinine (albumin-creatinine ratio)
• 2 out of 3 specimens submitted for testing within three to six-
month period are with abnormal findings.
Increased: Diabetic Nephropathy, fever,infection,
hypertention
Specimen: Random Urine
Method: Random-spot albumin- creatinine ratio
Reference value: 0-29 µg/mg creatinine
Microalbuminuria: 30-300 µg/mg creatinine
Clinical Albuminuria: >300 µg/mg creatinine
 2. CSF
PROTEINS
o CSF is an ultrafiltrate of plasma formed in the
choroid plexus of the ventricles of the brain
o CSF glucose and protein analyses- blood sample is
analyzed concurrently
o CSF normally contains very little protein – proteins
in the blood do not cross easily in BBB
o CSF Albumin: 10-30 mg/dL (2/3 of the CSF total
protein
 2. CSF
PROTEINS
Method: TCA, SSA,
Coomassie Brilliant Blue Increased: Bacterial,Viral
Dye, Lowry and Kinetic and fungal meningitis,
Biuret Reaction
Traumatic tap, Multiple
sclerosis, Intracerebral
Decreased: Intracranial hemorrhage, Myxedema,
hypertension,
Hyperthyroidism, Leakage
Drug toxicity
of CSF due to trauma

Reference values: 15-45 mg/dL

 NOTES to REMEMBER:
1. CSF Oligoclonal banding
 Presence in CSF of 2 or more IgG bands in the
gamma region
 Seen in multiple sclerosis
- 90% of patients show oligoclonal bands in the
gamma region of the protein electrophoresis)
- (+) result fot CSF: ≥ 2 bands in the CSF not
present in serum
 Other disorders with 2 or more bands in the CSF:
 Encephalitis
 Neurosyphilis
 Guillain-Barre Syndrome
 Neoplastic Disorder
 2. Aminoacidopathies
 Inherited disorder of amino acid metabolism
 Exist either the activity of a specific enzyme in the
metabolic pathway or in the membrane transport
system for amino acids
2. a. Alkaptonuria
 Inborn error of metabolism characterized by the
absence of homogentisate oxidase in the tyrosine
pathway
Clinical feature: Ochronosis (tissue pigmentation)
Diagnostic indicator: Darkening of urine upon
standing at RT
 2. b. Homocystinuria
 Characterized by impaired activity of Cystathione-β-
synthetase
 Results to elevated levels of homocysteine and methionine
in blood and urine
Clinical features:
 Physical defects
 Thrombosis
 Osteoporosis
 Eye lens abnormality
 Mental retardation
Screening test:
Modified Guthrie Test (L-methionine
sulfoximine – antagonist)
 2. c. Maple Syrup Urine Disease
(MSUD)
 Characterized by markedly reduced or absence of α-
ketoacid decarboxylase
 Results to accumulation of branched-chain amino acids
(leucine, isoleucine, valine) in blood, urine and CSF)
Clinical features:
 Failure to thrive
 Muscular rigidity
 Mental Retardation
Screening Test: Modified Guthrie Test (4- azaleucine –
antagonist)
Diagnostic Test: Amino Acid Analysis
Indicator: 4mg/dl of Leucine
 2. d. Phenylketonuria
 Autosomal recessive trait characterized by the
deficiency of the enzyme phenylalanine
hydrolase (PAH)/phenylalanine-4-mono-
oxygenase, which catalyzes the conversion of
phenylalanine tyrosine
 Characterized by the presence of phenylpyruvic
acid (prime metabolite) in both blood and urine
in elevated concentration
 Deficiency of tetrahydrobiopterin (BH4)
 Results in elevated blood levels of phenylalanine
 2. d. Phenylketonuria
Reference value for serum phenylalanine: 1.2-3.4
mg/dL(70-200 µmol/L
Clinical features: Retarded mental development
(infants and children)
Diagnostic indicators:
 >1200 µmol/L of phenylalanine in the blood
 “Musty odor” of urine
Screening test: Guthrie Bacterial Inhibition Assay
(Bacillus subtilis spores and β 2-thienylalanine
antagonist)
(+) result = bacterial growth if the phenylalanine is
>4mg/dL
 2. e. Tyrosinemia

 Characterized by the deficiency of either

enzymes:
 Fumarylacetoacetate FAA hydrolase
(Tyrosinemia I)
 Tyrosine aminotransferase (Tyrosinemia II)
 4-hydroxyphenylpyruvic acid oxidase
(Tyrosinemia III)
 Accompanied by elevated methionine and p-
hydroxyphenylpyruvic acid in blood
 Deficiency leads to liver damage or cirrhosis
 TEST MEASURING THE HEPATIC
SYNTHETIC FUNCTION
• It is useful for quantitating the severity of hepatic
dysfunction
• Serum albumin and the Vitamin K-dependent
coagulation factors provide the most useful indices
for assessing severity of liver disease
 A. TOTAL PROTEIN
• In measuring total proteins in serum, fasting may not be
required
• Analysis of proteins is important for assessing nutritional
status and the presence of severe diseases involving the
liver, kidney and bone marrow
• Total protein and albumin are about 10% higher in the
ambulatory individuals
• Plasma levels of total protein is 0.2 to 0.4g/dL higher
than serum due to fibrinogen
• Transudates have a total protein of <0.3g/dL (<50% of
the serum total protein); exudates has >3g/dL
 A. TOTAL PROTEIN
• Is usually performed on serum, which has no
fibrinogen and no anticoagulant that may slightly
dilute proteins in plasma
• Hemolysis may falsely elevate the total protein
• Reference value: 6.5-8.3 g/dL
 1. KJELDAHL
METHOD
• Is the reference method but not routinely used
• It is based on measurement of the nitrogen content of
the protein
• It uses serum treated with tungstic acid, forming
protein-free filtrate (PFF)
• According to Kjeldahl, 1 gram of nitrogen is
equivalent to 6.54 grams of proteins
• 15.1%-16.8% = nitrogen content of proteins
• Reagent: H2SO4 (digesting agent)
• End product: AMMONIA
 2. BIURET METHOD
• Is the most widely used method, recommended by
the IFCC expert panel
• It is extensively used in clinical labratories,
particularly in automated analyzer in which protein
concentration can be measured down to 10-15
mg/dL
• It requires at least 2 peptide bonds and an alkaline
medium
• Reference value: 6.5-8.3 g/dL
2. BIURET METHOD
 2. BIURET METHOD
• Principle: Cupric ions complex the group
involved in the peptide bond forming a violet-
colored chelate which is proportional to the
number of peptide bonds present and reflects
the total protein level at 540nm.
• Reagents:
• Alkaline Copper Sulfate
• Rochelle Salt (NaK Tartrate)
• NaOH and Potassium Iodide
 3. FOLIN-CIOCALTEU
(LOWRY) METHOD
• It has the highest analytical sensitivity
• Principle: Oxidation of phenolic compounds
such as tyrosine, tryptophan and histidine to
give a deep blue color
• Main reagent: Phosphotungstic-molybdic
acid or phenol reagent
• Color enhancer: Biuret reagent
 4. ULTRAVIOLET ABSORPTION
METHOD
• Principle: the absorbance of proteins at 210nm
is due to the absorbance of the peptide bonds at
specific wavelength
• Proteins absorbs light at 280nm and at 210nm
• Absorption at 280nm is due to tryphtophan,
tyrosine and phenyalanine
 6. SERUM PROTEIN
ELECTROPHORESIS
• Principle: migration of charged particles in an electric
field; confirmatory
• The single most significant clinical application of SPE
is for the identification of monoclonal spike of
immunoglobulins and differentiating them from
polyclonal hypergammglobulinemia, is elevated APR
(AAT, haptoglobin, α1 antichymotrypsin)
• Major proteins that contribute to electrophoresis:
albumin, α1 antitrypsin, a2-macroglobulin, haptoglobin,
β-lpp, transferrin complement C3, fbgn, & Ig’s
• Confirmatory test for multiple myeloma
 NORMAL SPE PATTERN
ALBUMIN (1ST BAND) – Fastest band
A1-globulin (2nd fastest band)  glycoproteins, AAT (90%), AAG, TBG
A2-globuliin (3rd fastest band)  Ceruloplasmin, Haptoglobin, AMG
Beta-globulin (4th band)  Transferrin (90%), B-lpp, hemopexin, complement (C3 &C4)
Gamma-globulin (5th band; slowest band)  Immunoglobulin and CRP
 REFERENCE VALUES
FOR EACH FRACTION
1. ALBUMIN - 53-65% (3.5-5.0g/dL)
2. A1- globulin - 2.5-5% (0.1-0.3g/dL)
3. A2-globulin - 7-13% (0.6-1.0g/dL)
4. β-globulin - 8-14% (0.7-11g/dL)
5. γ-globulin - 12-22% (0.8-1.6g/dL)
ABNORMAL
SPE
PATTERNS
ABNORMAL SPE
PATTERNS
 6. REFRATOMETRY
• Is an alternative test to chemical analysis
of serum total proteins
• It is based on measurement of refractive
index of solutes in serum
 7. TURBIDIMETRIC AND
NEPHELOMETRIC METHODS
• These methods utile sulfosalicylic acid and or
trichloroacetic acid.
• Measurements depends on the formation of uniform
fine precipitate which scatters incident light in
suspension (nephelometry) or block light
(turbidimetry)
 8. SALT FRACTIONATION
• Globulins can be separated from abumin by salting-out
procedures using sodium salts.
• Reagent: Sodium sulfate salt
• The albumin that remains in solution in the supernatant can be
measured by any of the routine total protein methods; globulin is
insoluble in water but not in dilute salt solution

SOLUBILITY PROPERTY OF PROTEINS

PROTEIN SOLUBLE INSOLUBLE
ALBUMIN Water Saturated salt solution
Concentrated salt solution Highly concentrated salt solution
Hydrocarbon solvents
GLOBULIN Weak salt solution Water
Hydrocarbon solvents Saturated salt solution
Concentrated salt solution
9. OTHER MEASUREMENTS
FOR PROTEIN
• Coomassie Brilliant Blue Dye is for detection
of proteins to as little ass 1 ug.
• Ninhydrin, which develops a violet color by
reacting with primary amines, is widely used
for detection of peptides and aa after paper
chrom; aa analyses from ion-exchange
columns; as well ass for detection of drugs on
toxicology screens using thin layer chrom.
 CLINICAL
SIGNIFICANCE
INCREASED TOTAL DECREASED TOTAL
PROTEIN: PROTEIN:

1. Malignancy 1. Hepatic Cirrhosis

2. Multiple Myeloma 2. Glomerulonephritis
3. Waldenstrom’s 3. Nephrotic syndrome
macroglobulinemia 4. Starvation
 B. PROTHROMBIN
TIME (VIT.K
RESPONSE TEST)
• It differentiates intrahepatic disorder (prolonged protime)
from extrahepatic obstructive liver disease (normal
protime)
• Prolonged protime despite Vit. K administration indicate
loss of hepatic capacity to synthesize the proteins
• In acute viral or toxic hepatitis, prolonged protime
signifies massive cellular damage
• Vitamin K is administered inramuscularly, 10mg daily
for 1-3 days
• 2nd Synthetic function test
 ALBUMIN
• Concentration of this protein is inversely proportional to
the severity of the liver disease
• Plasma levels decline when severe hepatocellular disease
last more than 3 weeks
• In hepatic circulatory disorder, albumin is used because its
concentration reflects the shift of protein and fluid into
ascites and its important contribution to the plasma oncotic
pressure
• Decreased serum albumin concentration may be due to
decrease synthesis
• Low total protein + low albumin = hepatic cirrhosis and
nephrotic syndrome
 DYES USED FOR
MEASUREMENT:
1. Bromcresol green (BCG)  most commonly used
2. Methyl orange (MO)
3. Hydroxyazobenzene benzoic acid (HABA)
4. Bromcresol Purple (BCP) most specific dye
• Albumin can be measured by direct methods based on its dye-binding
property
• BCG and BCP are cationic dyes, and free from interference from
bilirubin
• BCG and BCP are not significantly affected by the used of hemolyzed
samples
• BCG is used extensively in automatic analyzers for determining
serum albumin in parallel with Biuret reagent for total protein
• The presence of penicillin may cause falsely low result of albumin
(BCG method)
 CLINICAL SIGNIFICANCE OF
ALBUMIN
HYPOALBUMINEMIA ANALBUMINEMIA
HYPERALBUMINEMI
A 1. REDUCED SYNTHESIS  Is hereditary absence of
1. CHRONIC LIVER DSE albumin; inability to
1. Severe 2. MALABSORPTION
SNYNDROME
synthesize albumin
dehydration 3. MALNUTRITION AND BISALBUMINEMIA
MUSCLE WASTING
2. Prolonged DISEASE  Is the presence of two
2. INCREASED LOSS albumin bands instead
tourniquet 1. NEPHROTIC SYNDROME of a single band in
application- 2. MASSIVE BURNS electrophoresis
pseudo 3. PROTEIN-LOSING
ENTEROPATHY  It is associated with
hyperalbuminem 4. ORTHOSTATIC
ALBUMNURIA
excess amount of
therapeutic drugs in
ia 3. INCREASED serum (penicillin)
CATABOLISM
1. MASSIVE BURNS
2. WIDESPREAD
MALIGNANCY
3. THYROTOXICOSIS
 ALBUMIN/GLOBULIN
RATIO
• It is determined to validate if globulin is higher than
albumin
• If globulin is greater than albumin it is known as
inverted A/G ratio seen in cirrhosis, MM and
Waldenstrom’s macroglobulinemia
• Serum and even urine protein electrophoresis may help
define the clinical situations
• Reference value: 1.3-3.1
 PROTEIN LEVELS IN DISEASE
STATES
ALBUMI GLOBULI
TOTAL PROTEIN DISEASE
N N
Cirrhosis, Hepatitis, Obs.
N,
Jaundice

N Nephrosis, Malabsorption

NaCl Retention Syndrome

Dehydration

N Multiple Myeloma