Total Protein: albumin and globulins explained

What is total protein and why is it tested

Total protein in the blood covers two main groups: albumin and globulins. Albumin, produced by the liver, makes up the largest share and is responsible for fluid balance and the transport of substances. Globulins include immunoglobulins (antibodies) that fight infections, as well as transport and inflammatory proteins. Total protein is assessed as an indicator of general health, liver function, immune system status, and nutrition. It is often measured alongside albumin as part of a comprehensive metabolic panel.

Reference ranges

The normal total protein concentration in adults is 6.0–8.3 g/dL (or 60–83 g/L). Albumin accounts for approximately 3.5–5.0 g/dL, with the remainder being globulins. Subtracting albumin from total protein gives the globulin fraction — this is an important diagnostic ratio. Reference ranges may vary slightly between laboratories.

Why total protein may be elevated

Elevated total protein can indicate a chronic infection or inflammation, when the body produces more immunoglobulins. Autoimmune diseases (e.g., rheumatoid arthritis, lupus) also raise globulin levels. Rarer causes include plasma cell tumours such as multiple myeloma, where one type of antibody is produced in abnormally high amounts. Dehydration can create a misleadingly elevated result. Chronic liver disease can sometimes raise globulins even as albumin falls.

Why total protein may be low

Low total protein most often means albumin is reduced — due to liver disease, nutritional deficiency, or protein loss through the kidneys (nephrotic syndrome) or the gastrointestinal tract (malabsorption, inflammatory bowel disease). Agammaglobulinaemia or immunodeficiencies reduce the globulin portion. Prolonged fasting, anorexia, severe burn injuries, and acute infection (sepsis) can also lower total protein.

What to do with your result

If total protein is outside the normal range, the first step is to identify which fraction has changed — albumin or globulins. Your doctor may order a separate albumin test and serum protein electrophoresis (SPEP), which shows the precise distribution of globulins. Additional tests may include liver function markers, kidney markers, inflammatory markers, and quantitative immunoglobulin measurement.

Monitoring over time

Total protein is a useful baseline marker, but changes are best interpreted alongside albumin and the globulin fractions. Regular monitoring is meaningful for those with chronic liver disease, autoimmune conditions, or immunodeficiency. QbiLabs allows you to track total protein alongside albumin — helping you see the ratio and trends over time.

Questions to ask your doctor

1. Is the deviation on the albumin side or the globulin side? 2. Should I have a protein electrophoresis performed? 3. Could my liver or kidney function explain this change? 4. Is this result related to the state of my immune system? 5. How often should I repeat this test?