Investigative algorithms for disorders affecting plasma proteins with a focus on albumin and the calculated globulin fraction: a narrative review
Louise E. Duvall, Alexa R. Shipman, Kate E. Shipman
Abstract
Background and Objective: The following article is part of a special series to aid the reader in diagnosing the cause of various protein derangements. By the end of the article, the reader will be able to order and interpret appropriate investigations when faced with a patient with hypoproteinaemia or hyperproteinaemia. Methods: A narrative, focused literature review was performed using Medline, OMIM and Google during December 2022 to January 2023 to identify references published from database inception to January 2023; reference lists from these articles were also used. Language was restricted to English. Key Content and Findings: There is huge abundance of protein within the body with a spectrum of over 12,000 different proteins. The main contributors to serum total protein measurement are the albumin and globulin fraction. Excesses and deficiencies can occur in these two fractions due to many different disease states that can lead to significant morbidity and mortality. A laboratory approach to the investigation of hypoalbuminaemia, hypoglobulinaemia and hyperglobulinaemia is present. There are many conditions that can cause protein imbalances and the clinical status and condition of the patient should be considered to carry out a targeted investigation. Conclusions: Diagnostic flow charts have been created to help aid healthcare professionals rapidly diagnose and elicit the cause of hypoproteinaemia or hyperproteinaemia in their patients. These algorithms have been present and created within the limitations of the laboratory tests discussed within the paper.