Albumin & Globulins: Liver Proteins You Can’t Live Without

The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.


The liver is the body’s largest internal organ. It is responsible for numerous chemical processes and vital functions that the body needs for survival. Some of the key roles include:

  • The break down and detoxification of harmful substances in the body
  • Acting as a storage unit for nutrients such as glycogen (the stored form of glucose), vitamins and iron
  • Regulating the level of amino acids (building blocks of proteins) in the body
  • Help in the clearing of drugs and other chemicals from the body
  • Aid in clearance of bilirubin, a pigment formed by the breakdown of red blood cells. When there is an accumulation of bilirubin in the body, the skin and eyes turn yellow.

What Are Liver Function Tests?

Liver function tests (LFTs) basically track the levels of proteins, enzymes, and byproducts such as bilirubin. The most commonly used liver function tests include:

  • Albumin level
  • Total protein level
  • Alanine Transaminase (ALT)
  • Alkaline Phosphatase (ALP)
  • Aspartate Transaminase (AST)
  • Gamma-glutamyl transpeptidase (GGT)
  • Bilirubin (direct, indirect and total)

Protein portion of the LFT informs about the productive capacity of the liver. Enzymes portion of the LFT (transaminases- ALT, AST) informs about any inflammatory or other process (cellular integrity), and the bilirubins tell us if there is any obstruction of the bile (together with GGT and ALP). However this classification is rather simplistic and many cross-over in LFT abnormalities can be seen in most liver diseases. It would be wise to let your doctor do the complicated interpretation for you.

In this article, our main focus is on Albumin and Total Protein levels.

Total Protein

According to the American Liver Foundation, the total protein test measures the total amount of albumin and globulin in the blood. Albumin (which constitutes 60% of all proteins in the blood) is a type of protein that prevents water from leaking out of blood vessels and transports hormones and other critical substances throughout the body. Globulin, on the other hand, makes up 40% and include enzymes, antibodies, hormones, carrier proteins, and numerous other types of proteins.

The normal levels of total proteins range from 6.3 to 7.9 grams per deciliter.

Albumin

The albumin test measures how well the liver is making albumin. The normal range is between 3.5 and 5.0 grams per deciliter,  and a low result indicates that the liver is not functioning properly. Albumin is the main protein made by the liver, thus a good indicator of the liver’s protein making capacity.

Albumin levels can decrease when production by the liver is reduced (typically occurs when liver is severely affected, or malnutrition), when there is excessive protein breakdown, excessive loss via the kidneys (usually chronic kidney disease from hypertension or diabetes), or when there is a diluted effect in the blood (congestive cardiac failure).

Why Are Liver Function Tests Done?

Liver function tests are carried out to assess how well the liver is working. The tests may be performed as part of a routine checkup, when liver damage, failure or disease are suspected, or to monitor the progress of treatment. Albumin in particular is useful when there is unexplained weight loss, symptoms of malnutrition, or prior to planned surgery.

Signs and Symptoms to Watch Out For

Liver protein tests give us an idea of whether the liver is functioning normally. Thus, most of the signs and symptoms are related to a problem with the liver. However, malnutrition and kidney disease (with their respective symptons) can also reduce our protein levels. The commonest manifestations of liver malfunction include:

  • Swelling of the legs and ankles
  • Abdominal pain and swelling
  • Yellowish skin and eyes (jaundice)
  • Loss of appetite
  • Persistent fatigue
  • Itchiness

Main Causes of Abnormal Total Protein and Albumin Levels?

If the levels of total protein and albumin levels are out of the normal ranges, then there is a problem that needs medical attention for further investigation and management. For total proteins, if the levels are high, it may indicate excessive loss of body water (dehydration), accumulation of proteins due to an infection or due to cancers such as multiple myeloma, a cancer that produces abnormal proteins.

Low total proteins are suggestive of a liver disorder (reduced production), kidney disease (excessive loss) or a digestive problem where proteins are not digested and absorbed properly (leading to malnourishment).

Low albumin levels are also suggestive of liver disease, severe infection, shock, poor nutrition, and excess protein loss such as in kidney disease or extensive burns. High levels are indicative of dehydration or a high protein diet that is common in bodybuilders.

How to Balance Liver Protein Tests

If one is well, the best ways to take care of the liver is by avoiding fad diets which cause strain to the liver and kidneys, unnecessary medications, contaminated needles during tattooing, smoking, and excessive alcohol. The American Liver Foundation also advises that sticking to a healthy diet, exercising, maintaining healthy body weight and getting hepatitis A and hepatitis B vaccines also protect the liver from damage.

When to See the Doctor

Any abnormality in your protein levels are cause for medical attention. Not only should the underlying cause of the abnormality be addressed but also the complications of excessive protein loss or underproduction.

Abnormal liver functioning can cause serious complications that require immediate medical attention. The warning signs include:

  • Excessive pain
  • Yellowing of the skin and eyes
  • Excessive vomiting
  • Easy bruising
  • Restlessness

Additional Tests

Most of the times, single abnormal test results are not adequate to make a diagnosis. The doctor will often order other tests to point out the exact problem. Other tests that may be appropriate include a complete blood cell count (CBC) to evaluate all the cells that make up blood, hepatitis screening, blood clotting test to measure how long it takes for blood to form a clot, other liver function tests (like albumin/globulin ratio), kidney function test, a metabolic screen) and an ultrasound to visualize the structure of the liver.

The liver is a critical organ that needs to be treated with utmost care. If the functionality of this organ is reduced, it compromises the health of most other body systems. For this reason, paying attention to all the signs that could indicate any problem is essential. Tracking the liver function tests to detect any condition is one of the best ways to take care of this vital organ.

Remember signs and symptoms appear often when its very late in the disease progress!


If you want to find out more about liver proteins and how you can balance liver protein tests, take a look at our lifestyle article here!

Interested in other biomarkers? Check out the rest of The Biomarker Handbook.

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