Total Protein

Total protein represents the sum of:

• Albumin
• Globulins

Normal range: 6.0 – 8.0 g/dL

It is an important parameter in evaluating nutritional status, liver function, kidney disease, and plasma cell disorders.

1️⃣ Liver Disease

Since most plasma proteins (except immunoglobulins) are synthesized in the liver:

↓ Total Protein in:

• Cirrhosis
• Chronic liver disease
• Severe hepatitis

🔎 Albumin decreases more markedly than globulins in liver failure.

2️⃣ Malnutrition

• Protein-energy malnutrition
• Kwashiorkor
• Malabsorption syndromes

👉 Leads to decreased total protein and hypoalbuminemia.

3️⃣ Renal Disease

In nephrotic syndrome:

• Loss of albumin in urine
• Decreased total protein
• Edema develops

4️⃣ Increased Total Protein (Hyperproteinemia)

Seen in:

A) Dehydration

• Hemoconcentration
• Relative increase in protein

B) Chronic Infections & Inflammation

Increased globulins

C) Multiple Myeloma

• Monoclonal immunoglobulin (M-protein)
• Marked increase in globulins
• M-spike on electrophoresis

5️⃣ Albumin:Globulin (A/G) Ratio

Normal A/G ratio: 1.2 – 1.8 : 1

Reversal of A/G ratio seen in:

• Chronic liver disease
• Multiple myeloma
• Chronic infections