Total Protein and Albumin/Globulin (A/G) Ratio

Why this test may be ordered

• As part of a routine checkup (often included in a comprehensive metabolic panel)
• To help diagnose kidney disease, liver disease, or nutritional problems
• To monitor a health condition that affects protein levels
• If you have symptoms such as swelling in the feet, ankles, legs, or abdomen, fatigue, unexplained weight loss, loss of appetite, nausea, vomiting, jaundice, or blood in the urine

Preparation and collection

You may need to stop taking certain medicines before this test; tell your health care provider about everything you take. If this 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.

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. This usually takes less than five minutes.

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.

Understanding results

Your results will show whether you have normal, low, or high total protein levels and whether you have a normal, low, or high albumin to globulin (A/G) ratio. Your provider will consider your symptoms, medical history, and the results of other blood tests to understand the results. If you have questions about your results, talk to your provider.

• Low total protein levels: May be a sign of liver disease, kidney disease, malnutrition, or a malabsorption syndrome (such as celiac disease or Crohn's disease). Limitation: These results are not diagnostic on their own; your provider will consider your symptoms, medical history, and other test results. Next step: Your provider will discuss follow-up testing and evaluation based on your overall health picture.
• High total protein levels: May be a sign of an infection such as HIV or viral hepatitis, or multiple myeloma (a type of blood cancer). Limitation: These results are not diagnostic on their own; your provider will consider your symptoms, medical history, and other test results. Next step: Your provider will discuss follow-up testing and evaluation based on your overall health picture.
• Low A/G ratio: May be caused by an autoimmune disease (such as lupus), liver disease (including cirrhosis), or kidney disease. Limitation: These results are not diagnostic on their own; your provider will consider your symptoms, medical history, and other test results. Next step: Your provider will discuss follow-up testing and evaluation based on your overall health picture.
• High A/G ratio: May be caused by certain types of genetic disorders or leukemia (cancer of the blood cells). Limitation: These results are not diagnostic on their own; your provider will consider your symptoms, medical history, and other test results. Next step: Your provider will discuss follow-up testing and evaluation based on your overall health picture.

• Results are not diagnostic on their own; they must be interpreted by a healthcare professional in the context of your symptoms, medical history, and other test results.
• Low albumin levels can be normal during pregnancy.
• The test does not specify the exact cause of abnormal protein levels; further testing may be needed.
• Certain medicines can affect test results; tell your provider about everything you take.

What to do next

If your results are not normal, your provider will consider your symptoms, medical history, and the results of other blood tests to understand the results. You may need additional tests, such as a separate albumin test or serum electrophoresis to measure different types of globulins. Talk to your provider about what your results mean and any recommended follow-up.

• What do my total protein and A/G ratio results mean for my health?
• Do I need any additional tests based on these results?
• Should I be concerned about any specific symptoms I am having?
• Are there any medicines I am taking that could affect these results?
• How often should I have this test repeated?

Evidence source

U.S. National Library of Medicine: Total Protein and Albumin/Globulin (A/G) Ratio