What is a total protein and albumin/globulin (A/G) ratio test?

A total protein and albumin/globulin (A/G) ratio test measures the total amount of protein in your blood. Proteins have many important functions, including giving your body energy, rebuilding muscles, and helping your immune system. Your body might make too much or too little protein if you have certain health conditions.

There are two major types of protein in the blood: albumin and globulin. Albumin makes up most of the protein in the blood, while the rest are called globulins.

• Albumin, which helps keep fluid from leaking out of blood vessels. It also helps move hormones (chemical messengers in your bloodstream that control the actions of certain cells or organs), medicines, vitamins, and other important substances throughout your body. Albumin is made in the liver.
• Globulins, which help fight infection and move nutrients throughout your body. Some globulins are made by the liver. Others are made by the immune system.

The test also compares the amount of albumin in your blood to the amount of globulin. This comparison is called the albumin/globulin (A/G) ratio.

This test can check how well your liver and kidneys are working and if you are lacking some nutrients needed for good health. If your total protein levels or A/G ratio results are not normal, it can be a sign of a serious health problem.

Other names: total serum protein, TP albumin/globulin ratio, Total protein with A/G ratio

What is it used for?

A total protein and A/G ratio test is often included as part of a comprehensive metabolic panel (CMP), a test that measures proteins and other substances in your blood. A total protein and A/G ratio test may also be used to help diagnose kidney disease, liver disease, or nutritional problems.

Why do I need a total protein and A/G ratio test?

You may get this test as part of a comprehensive metabolic panel, which is often included in a routine checkup. You may also need this test to check for or monitor a health condition that affects the amount of protein in your body or if you have symptoms that indicate abnormal protein levels. These can include:

• Swelling in the feet, ankles, legs, and/or abdomen (belly), which is caused by extra fluid in your tissues
• Fatigue
• Unexplained weight loss
• Loss of appetite
• Nausea and vomiting
• Jaundice (yellowing of the skin or eyes). This is a common symptom of liver disease.
• Blood in the urine, a common symptom of kidney disease

What happens during a total protein and A/G ratio test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for this test?

You may need to stop taking certain medicines before this test, so tell your health care provider about everything you take. But don't stop taking any medicines unless your provider tells you to.

If your total protein and A/G ratio test is part of another blood test, you may need to fast (not eat or drink) for several hours before the test. Your provider will let you know if there are any special instructions to follow.

Are there any risks to this test?

There is very little risk to having a blood test. There may be slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

Your results will show whether you have normal, low, or high total protein levels. They will also show if you have a normal, low, or high albumin to globulin (A/G) ratio.

If your total protein levels were low, it may be a sign of one of the following conditions:

• Liver disease
• Kidney disease
• Malnutrition, a condition in which your body does not get the calories, vitamins, and/or minerals needed for good health
• A malabsorption syndrome, a type of disorder in which your small intestine can't absorb enough nutrients from food. Types of malabsorption syndromes include celiac disease and Crohn's disease.

If your total protein levels were high, it may be a sign of one of the following conditions:

• An infection such as HIV or viral hepatitis
• Multiple myeloma, a type of blood cancer

If your A/G ratio was low, it may be caused by:

• An autoimmune disease, such as lupus
• Liver disease, including cirrhosis
• Kidney disease

If your A/G ratio was high, it may be caused by:

• Certain types of genetic disorders
• Leukemia (cancer of the blood cells)

Your provider will consider your symptoms, medical history, and the results of other blood tests to understand the results of this test. If you have questions about your results, talk to your provider.

Learn more about laboratory tests, references ranges, and understanding results.

Is there anything else I need to know about a total protein and A/G ratio test?

In addition to total protein levels, your provider may order a separate blood test for albumin and/or a test for globulins. The globulins test is called serum electrophoresis. It is a blood test that measures the levels of four different types of globulins.

These results may show the following:

Low albumin levels may be a sign of:

• Liver disease, including cirrhosis
• Kidney disease
• Malnutrition
• Thyroid disease
• Severe burns

if you are pregnant, a low albumin level is normal.

High albumin levels may be a sign of:

• Severe dehydration
• Diarrhea

Low globulin levels may be a sign of:

• Liver disease
• Kidney disease

High globulin levels may be a sign of:

• Certain types of blood cancers, such as multiple myeloma, Hodgkin disease, or leukemia
• Hemolytic anemia
• An autoimmune disease, such as lupus or rheumatoid arthritis
• Tuberculosis