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Liver and pancreas · Blood
Albumin/globulin ratio
Albumin divided by globulin; a calculated ratio that adds little to the separate values of total protein and albumin.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
Albumin/globulin ratio: what is measured?
The albumin/globulin ratio is calculated: albumin divided by globulin. Globulin is itself also calculated, as total protein minus albumin. So only two things are actually measured: total protein and albumin. Normally there is more albumin than globulin in the blood, so the ratio is above 1.
What can it detect?
- Relatively many globulins (antibodies) or little albumin with long-term inflammation, an autoimmune disease or a chronic infection (low ratio)
- Advanced liver disease (cirrhosis), in which albumin falls and globulin rises (low ratio)
- Relatively few antibodies, for example due to medicines that suppress the immune system (high ratio)
- Rarely: an M-protein (one type of antibody in large amounts)
Result
What does the result mean?
Albumin/globulin ratio too high
A high ratio means that there is relatively little globulin. This usually has no significance, certainly if total protein and albumin are normal. A higher ratio occurs with the use of medicines that suppress the immune system, such as prednisone. Rarely: a shortage of antibodies, which goes with frequently recurring respiratory infections.
Albumin/globulin ratio too low
A low ratio means that there is relatively little albumin or relatively much globulin. A slight fall is often due to a recent infection or inflammation: albumin then falls and the inflammation and immune proteins rise. A clearly and persistently low ratio fits long-term inflammation, an autoimmune disease, a chronic infection such as hepatitis, advanced liver disease or protein loss via the kidneys. Rarely: an M-protein, one type of antibody that is made in large amounts, usually in MGUS (a condition without symptoms) and very occasionally in Kahler's disease (multiple myeloma).
After an abnormal result
With an abnormal ratio, the GP looks at albumin and total protein separately, at inflammation markers (CRP) and at liver values, and repeats the measurement after recovery from any infection. If the ratio remains clearly abnormal, protein electrophoresis follows.
Reliability
How reliable is the test?
The ratio is calculated from total protein and albumin and adds nothing beyond those two separate values; measurement errors in both values carry through into the calculation. There are no agreed cut-off values or fixed meaning for the ratio itself. Albumin and total protein separately, and if needed protein electrophoresis, say more when there is an abnormality.
What can affect the result?
- Laboratories measure albumin with different methods, so the ratio differs per laboratory; there is no nationally agreed reference value.
- An infection or inflammation in the weeks before the sample collection lowers the ratio temporarily.
- Pregnancy and the contraceptive pill lower albumin and therefore also the ratio.
- Medicines that suppress the immune system can raise the ratio.
Who it is for
Who is the test useful for?
Useful for
The ratio is calculated automatically when total protein and albumin are measured, for example in an extended package for athletes, and adds little as a separate test. In healthy adults without symptoms, the ratio says little; with symptoms, the separate values say more.
How common is it?
How often an abnormal albumin/globulin ratio occurs in healthy adults has not been studied; most abnormalities are slight and temporary, for example after an infection. Of the underlying causes, an M-protein without symptoms (MGUS) occurs in about 3 in 100 people over 50; liver cirrhosis and a severe shortage of antibodies are much rarer.
NVKC; Jeroen Bosch Hospital (MGUS)
Drawbacks and risks
- A slightly abnormal ratio often has no significance, but without explanation it can lead to unnecessary worry and follow-up testing.
Get tested
Albumin/globulin ratio: test panels
Albumin/globulin ratio is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
Other tests: Liver and pancreas
- ALAT
- Albumin
- Alkaline phosphatase
- Alpha-1 antitrypsin
- Amylase
- ASAT
- Bilirubin direct (conjugated)
- Bilirubin indirect (unconjugated)
- Bilirubin total
- Ceruloplasmin
- Cholinesterase
- Gamma-GT