• Also Known As:
  • TP
  • Albumin/Globulin Ratio
  • A-G Ratio
  • Formal Name:
  • Total Protein
  • Albumin to Globulin Ratio
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At a Glance

Why Get Tested?

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

When To Get Tested?

When you have a routine health exam; when you experience unexpected weight loss or fatigue, or when your healthcare practitioner thinks that you could have symptoms of a liver or kidney disorder

Sample Required?

A blood sample drawn from a vein or by fingerstick or, in the case of newborns, by heelstick

Test Preparation Needed?

None

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You can order your own FDA approved laboratory testing online or by phone and walk-in to a local lab location with a lab requisition to have your testing services performed. Direct-access laboratory testing provides the same FDA approved tests ordered by your physician from the same CLIA certified laboratories. You pay private-pay prices with a credit card, online checkout is easy. There are no additional fees for lab services or blood work. We do not bill your health insurance company.

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 amount of protein in your blood.

Two classes of proteins are found in the blood, albumin and globulin.

  • Albumin is made by the liver and makes up about 60% of the total protein. Albumin keeps fluid from leaking out of blood vessels, nourishes tissues, and transports hormones, vitamins, drugs, and substances like calcium throughout the body.
  • Globulins make up the remaining 40% of proteins in the blood. The globulins are a varied group of proteins, some produced by the liver and some by the immune system. They help fight infection and transport nutrients.

The test also compares the amount of albumin with globulin and calculates what is called the A/G ratio. A change in this ratio can provide your healthcare practitioner with a clue as to the cause of the change in protein levels.

Total protein levels in the blood may increase or decrease, to a greater or lesser degree, with various conditions.

Total protein levels may decrease in conditions that:

Total protein levels may increase with conditions that cause:

Common Questions

How is the test used?

Total protein and albumin tests may be used, along with other tests included in panels such as a comprehensive metabolic panel (CMP), to help evaluate your overall health status.

These tests may also be used to help diagnose diseases and to monitor conditions or treatments. Total protein levels can be affected by many different diseases and disorders. For example, a total protein test may be used to help diagnose kidney disease or as part of a liver panel to help detect liver disease.

Results may indicate the need further testing. If total protein is abnormal, your healthcare practitioner may recommend follow-up tests, such as protein electrophoresis and quantitative immunoglobulins.

Some laboratories report total protein, albumin, and also the calculated ratio of albumin to globulins, the A/G ratio. The A/G ratio may provide a clue as to the cause of the change in protein levels.

When is it ordered?

A total protein test is frequently ordered as part of a comprehensive metabolic panel (CMP) when you have a routine health checkup.

Total protein may also be ordered if you have signs and symptoms, such as:

What does the test result mean?

Results of a total protein test are evaluated along with those from other tests of the CMP. If results are abnormal, further tests are required to identify which protein is high or low before your healthcare practitioner can make a diagnosis.

Some examples of conditions that cause low total protein include:

Some examples of conditions that cause high total protein include:

Low A/G ratio may be caused by:

  • Overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases
  • Underproduction of albumin, such as may occur with cirrhosis
  • Selective loss of albumin from the circulation, as may occur with kidney disease (nephrotic syndrome)

High A/G ratio may be caused by:

  • Underproduction of immunoglobulins as happens in some genetic deficiencies
  • Leukemias

Will a high protein diet raise my total protein level?

No, eating more protein will not increase your total protein test result.

What type of nutrition is recommended for optimal protein levels?

There is no specific diet. A well-balanced diet that follows the recommendations of the United States Department of Agriculture is summarized by the USDA Choose My Plate.

What are globulin proteins and how are they measured in blood?

Globulins are a group of proteins in the blood, some produced by the liver and some by the immune system. They help fight infection and transport nutrients. There are four main types: alpha 1, alpha 2, beta, and gamma. They are measured using different tests:

  • Total protein test—measures albumin and globulin
  • Serum protein electrophoresis—can be used to measure the different groups of globulin proteins

Can protein be measured in samples other than blood?

Yes, a test for protein can be performed on many different types of body fluids. Proteins are also measured in urine. The purpose of urine testing and the meaning of results are different than from blood. See the articles on Body Fluid Testing, Urine Protein, and Urinalysis for more information.

Is there anything else I should know?

Many medications may affect total protein levels, including estrogens, steroids, and oral contraceptives. Tell your healthcare practitioner all the prescription or over-the-counter medications, supplements, or illicit substances you may be taking.

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

Health Professionals – LOINC

Logo for LOINC from RegenstriefLOINC Observation Identifiers Names and Codes (LOINC®) is the international standard for identifying health measurements, observations, and documents. It provides a common language to unambiguously identify things you can measure or observe that enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research. Learn More.

Listed in the table below are the LOINC with links to the LOINC detail pages. Please note when you click on the hyperlinked code, you are leaving Lab Tests Online and accessing Loinc.org.

LOINC LOINC Display Name
2885-2 Protein [Mass/Vol]
1751-7 Albumin [Mass/Vol]
43712-9 Albumin Ql
54347-0 Albumin [Moles/Vol]
1759-0 Albumin/Globulin [Mass ratio]

 

View Sources

Sources Used in Current Review

2019 review performed by Marina Marinkovic, PhD, Principal Scientist, Nova Biomedical.

What to know about the protein test and results. MedicalNewsToday. Available online at https://www.medicalnewstoday.com/articles/325320.php. Accessed 8/12/19.

What Is a Total Serum Protein Test? WebMed. Available online at https://www.webmd.com/a-to-z-guides/what-is-a-total-serum-protein-test#2. Accessed 8/12/19.

Total Protein and A/G Ratio. University of Rochester Medical Center. Available online at https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=total_protein_ag_ratio. Accessed 8/12/19.

Globulin Test. MedlinePlus. Available online at https://medlineplus.gov/lab-tests/globulin-test/. Accessed 8/12/19.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER and Bruns DE, eds. 4th ed. St. Louis, Missouri: Elsevier Saunders; 2006, Pp 543-546.

(May 17, 2007) Van Voorhees B. MedlinePlus Medical Encyclopedia. Total Protein. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003483.htm. Accessed April 2009.

Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp 231-236.

(November 3, 2007) Mayo Clinic: High protein in blood: What causes it? Available online at http://www.mayoclinic.com/health/protein-in-blood/AN01204. Accessed April 2009.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry. AACC Press, Washington, DC Pp 200, 206.

Dugdale, D. (Updated 2011 May 30). Total protein. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003483.htm. Accessed February 2013.

(© 1995–2013). Protein, Total, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/8520. Accessed February 2013.

Alvaran Tuazon, S. and Scarpaci, A. (Updated 2012 May 11). Serum Protein Electrophoresis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2087113-overview#showall. Accessed February 2013.

Gersten, T. (Updated 2012 February 8). Protein electrophoresis – serum. MedlinePlus Medical Encyclopedia [On-line information]. Available online at [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003540.htm. Accessed February 2013.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 799-804.

Clarke, W., Editor (© 2011). Contemporary Practice in Clinical Chemistry 2nd Edition: AACC Press, Washington, DC. Pp 233-246.

(© 1995–2016).Protein, Total, Serum. Mayo Clinic Mayo Medical Laboratories. [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8520. Accessed 3/23/16.

Bertholf, R. (2014). Proteins and Albumin. Medscape Multispecialty from Lab Med. 2014;45(1):e25-e41. [On-line information]. Available online at http://www.medscape.com/viewarticle/823421_6. Accessed 3/23/16.

Shah, D. and Seiter, K. (2016 February 5 Updated). Multiple Myeloma. Medscape Drugs and Diseases. [On-line information]. Available online at http://emedicine.medscape.com/article/204369-overview#showall. Accessed 3/23/16.

Delgado, J. (2015 December Updated). Proteins. ARUP Consult [On-line information]. Available online at https://arupconsult.com/content/proteins. Accessed 3/23/16.

Martin, L. (2015 May 3 Updated). Total protein. MedlinePlus Medical Encyclopedia [On-line information]. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/003483.htm. Accessed 3/23/16.

Durani, Y. (2014 August Reviewed). Hepatic (Liver) Function Panel. TeensHealth from Nemours [On-line information]. Available online at http://kidshealth.org/en/teens/test-liver-function.html. Accessed 3/23/16.

 

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