SERUM PROTEINS

Proteins are the most abundant compounds in your serum (the rest of your
blood when you remove all the cells). Amino acids are the building blocks of all
proteins. In turn proteins are the building blocks of all cells and body tissues.
They are the basic components of enzymes, many hormones, antibodies and
clotting agents. Proteins act as transport substances for hormones, vitamins,
minerals, lipids and other materials. In addition, proteins help balance the
osmotic pressure of the blood and tissue. Osmotic pressure is part of what
keeps water inside a particular compartment of your body. Proteins play a
major role in maintaining the delicate acid-alkaline balance of your blood.
Finally, serum proteins serve as a reserve source of energy for your tissues and
muscle when you are not ingesting an adequate amount.

The major measured serum proteins are divided into two groups, albumin and
globulins. There are four major types of globulins, each with specific properties
and actions. A typical blood panel will provide four different measurements -
the total protein, albumin, globulins, and the albumin globulin ratio.

Total Protein

Because the total protein represents the sum of albumin and globulins, it is
more important to know which protein fraction is high or low than what is the
total protein. Ideally, the total protein will be approximately 7.5 g/dl.

Optimal Range: 7.2-8.0 g/100ml

Total protein may be elevated due to:

 Chronic infection (including tuberculosis)

 Adrenal cortical hypofunction
 Liver dysfunction
 Collagen Vascular Disease (Rheumatoid Arthritis, Systemic Lupus,
Scleroderma)
 Hypersensitivity States
 Sarcoidosis
 Dehydration (diabetic acidosis, chronic diarrhea, etc.)
 Respiratory distress
 Hemolysis
 Cryoglobulinemia
 Alcoholism
 Leukemia

Total protein may be decreased due to:

  Malnutrition and malabsorption (insufficient intake and/or digestion of
proteins)
 Liver disease (insufficient production of proteins)
 Diarrhea (loss of protein through the GI tract)
 Severe burns (loss of protein through the skin)
 Hormone Imbalances that favor breakdown of tissue

 Loss through the urine in severe kidney disease (proteinuria)

 Low albumin (see "albumin")

 Low globulins (see "globulins")
 Pregnancy (dilution of protein due to extra fluid held in the vascular
system)

Albumin

Albumin is synthesized by the liver using dietary protein. Its presence in the
plasma creates an osmotic force that maintains fluid volume within the
vascular space. A very strong predictor of health; low albumin is a sign of poor
health and a predictor of a bad outcome.

Optimal Range: 4.5-5.0 g/100ml

Albumin levels may be elevated in:

 Dehydration - actual
 Congestive heart failure
 Poor protein utilization
 Glucocorticoid excess (can result from taking medications with cortisone
effect, the adrenal gland overproducing cortisol, or a tumor that
produces extra cortisol like compounds)
 Congenital

Albumin levels may be decreased in:

 Dehydration
 Hypothyroidism
 Chronic debilitating diseases (ex: RA)
 Malnutrition - Protein deficiency
 Dilution by excess H2O (drinking too much water, which is termed
“polydipsia,” or excess administration of IV fluids)
 Kidney losses (Nephrotic Syndrome)
 Protein losing-enteropathy (protein is lost from the gastrointestinal tract
during diarrhea)
  Skin losses (burns, exfoliative dermatitis)
 Liver dysfunction (the body is not synthesizing enough albumin and
indicates very poor liver function)
 Insufficient anabolic hormones such as Growth Hormone, DHEA,
testosterone, etc.

GLOBULINS, Total serum

Globulins are proteins that include gamma globulins (antibodies) and a variety
of enzymes and carrier/transport proteins. The specific profile of the globulins
is determined by protein electrophoresis (SPEP), which separates the proteins
according to size and charge. There are four major groups that can be
identified: gamma globulins, beta globulins, alpha-2 globulins, and alpha-1
globulins. Once the abnormal group has been identified, further studies can
determine the specific protein excess or deficit. Since the gamma fraction
usually makes up the largest portion of the globulins, antibody deficiency
should always come to mind when the globulin level is low. Antibodies are
produced by mature B lymphocytes called plasma cells, while most of the other
proteins in the alpha and beta fractions are made in the liver.

Optimal Range: 2.3-2.8 g/dL

Optimal Range (Alpha Globulin): 0.2-0.3 g/L

Optimal Range (Beta Globulin): 0.7-1.0 g/L

The globulin level may be elevated in:

 Chronic infections (parasites, some cases of viral and bacterial infection)

 Liver disease (biliary cirrhosis, obstructive jaundice)
 Carcinoid syndrome
 Rheumatoid arthritis
 Ulcerative colitis
 Multiple myelomas, leukemias, Waldenstrom's macroglobulinemia
 Autoimmunity (Systemic lupus, collagen diseases
 Kidney dysfunction (Nephrosis)

The serum globulin level may be decreased in:

 Nephrosis (A Condition in which the kidney does not filter the protein
from the blood and it leaks into the urine)
 Alpha-1 Antitrypsin Deficiency (Emphysema)
 Acute hemolytic anemia
 Liver dysfunction
 Hypogammaglobulinemia/Agammaglobulinemia
  

A/G (ALBUMIN/GLOBULIN) RATIO

The liver can function adequately on 20% of liver tissue, thus early diagnosis
by lab methods is difficult. A reversed A/G Ratio may be a helpful indicator.
With severe liver cell damage, the prolonged prothrombin time will not change
with ingestion of Vitamin K. The proper albumin to globulin ratio is 2:1. When
<1.7, there is may be a need for increasing stomach acidity. When >3.5 there
may be a need for stomach acidity and pepsin.

Optimal Range: 1.7-2.2

The AG ratio may be elevated in:

 Hypothyroidism
 High protein/high carbohydrate diet with poor nitrogen retention
 Hypogammaglobulinemia (low globulin)
 Glucocorticoid excess (can be from taking medications with cortisone
effect, the adrenal gland overproducing cortisol, or a tumor that
produces extra cortisol like compounds, low globulin)

The AG ratio may be decreased in:

 Liver dysfunction

Potassium is an extremely valuable electrolyte essential to heart and kidney

function as well as to the maintenance of blood and urine pH. It is the chief
electrolyte in the fluid of cells. In fact, only a small part of the total body
potassium is contained in the serum. Serum potassium values range from 3.5 to
5.0 mmol/L while the concentration inside the red blood cell is at least l5 to 20
times this amount. While only a part of the total body potassium is found in the
serum, proper serum values are critical to normal physiology, especially adrenal,
heart and renal functions. Potassium should always be viewed in relation to the
other electrolytes.

Optimum Values: 4.0 to 4.7 mmol/L.

Serum potassium is increased in:

 Renal Dysfunction.
 Adrenal Cortex under function. With hypoadrenia, you may get dizzy when
you sit or stand quickly, fatigue (especially feeling tired in the morning),
crave salt or salty foods, have a low systolic blood pressure, experience food
and/or environmental sensitivities, feel weak or tired after colds, stress or
 exercise, sweat easily with exertion, get shortness of breath after very
minimal exertion even though you are in shape, get colds and upper
respiratory tract infections easily, etc. Aldosterone is produced by the
adrenal cortex, with insufficient production, the body loses sodium in the
urine in exchange for potassium. This is why you may see a relatively low
sodium with a relative elevated serum potassium with adrenal cortex
underactivity. The adrenal corticosteroids also favor the anabolic over
catabolic balance. With less effect, there is less potassium in the cell and
more in the serum.
 Catabolic/Dysaerobic State. See aerobic metabolism webpage for more
about this.
 Metabolic Acidosis. The level in the serum goes up while the level inside
the cell goes down as the potassium is pumped out of the cell in exchange
for the excess hydrogen ion (acid).
 Respiratory Dysfunction causes elevated serum potassium because of the
effect it has on making the blood and tissues more acidic due to lack of
oxygen (hypoxia).
 Bradycardia.
 Massive Tissue Destruction. Although potassium is increased in the
serum, potassium may be needed because the largest store of potassium is
inside the cell. As they tissue is destroyed the potassium is lost and the
blood and then excreted.
 Diabetes without adequate insulin.

Serum potassium is decreased in:

 Diarrhea and/or vomiting.

 Adrenal Cortex over function. Aldosterone is produced by the adrenal
cortex, with excess production, the body reclaims sodium from the urine in
exchange for excreting potassium. This is why you may see relatively high
sodium with relative decreased serum potassium with adrenal cortex over
activity.
 Several Types of Anemia.
 Metabolic Alkalosis. Just the reverse of acidosis, the potassium level in the
serum goes down while the level inside the cell goes up as the potassium is
pumped into the cell in exchange for the hydrogen ion (acid).
 Diuretic Use.
 Familial Periodic Paralysis.
 Diets High in Refined Foods due to lack of potassium in the diet.
 Hypertension.
 Insulin use. Potassium moves into cells when there is use of glucose or
build-up of protein.
 Anabolic/Anaerobic States.
Taking potassium when your serum level is low without understanding the
dynamics of potassium can be dangerous. Since the serum only holds about 2%
of the body's potassium, it is possible that there is an excess of potassium in the
cell and a low level in the blood. This is why it is important to know what is your
aerobic status. For example, in an anabolic/anaerobic condition, there is excess
intra-cellular potassium and usually relatively decreased serum potassium.
Choosing agents like calcium and magnesium that drive the potassium out of the
cell is the preferred treatment strategy rather than giving more potassium…

Glucose

There should be none present. Appearance of sugar is usually associated with

diabetes or a renal filtering defect.

Albumin

A trace of albumin is not unusual, especially in athletically active persons. Large

amounts usually indicate svere renal disease.

Occult Blood

This indicates the presence of blood in the urine. A trace of blood in women may
not be abnormal, but at times may indicate cystitis. There should be none present
in men.

pH

This is the acidity-alkalinity of urine. It may range from 3.4 to 8.9. It can be
affected by diet or medication.

Specific Gravity

This indicates how concentrated the urine is. It may range from 1.005 to 1.030. It
is affected by diet, fluid, diuretics, and may be abnormal in fluid problems of
the body.

WBC/HPF (White Blood Cells / High Power Field of Microscope)

Usually it ranges from 0 to 6. There may be higher numbers in urine infections,

uncircumcised men, prostate infection or vaginal discharge. 8 to 20 or more in an
unspurn urine specimen that is a clean catch usually signifies a significant
infection.

RBC/HPF (Red Blood Cells / High Power Field of Microscope)

There should be no more than 0 to 2 per high power field in the urine in men. A
few red cells per high power field in women may not be unusual.

Mucus Threads

This is a common finding in urine since the entire urine system is

filled with mucus.

Calcium Oxalate Chrystals, Urate Chrystals

This is anormal finding in urine and is only significant in cases of

renal stones.

Bacteria

The findings of some bacteria in urine is not unusual. Significant

bacteria with white cells in large numbers indicate an infection, or
renal or prostae disorders.

Interpretation of PT and PTT in Patients with a Bleeding Syndrome

PT PTT
RESULT RESULT POSSIBLE CONDITION PRESENT

Prolonged Normal Liver disease, decreased vitamin K, decreased or defective factor VII

Normal Prolonged Decreased or defective factor VIII, IX, or XI, or lupus anticoagulant present

Prolonged Prolonged Decreased or defective factor I, II, V or X, von Willebrand disease, liver disease,
disseminated intravascular coagulation (DIC)

Normal Normal Decreased platelet function, thrombocytopenia, factor XIII deficiency, mild deficiencies in
other factors, mild form of von Willebrand’s disease