Blood draw
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Liver and pancreas · Blood
Globulin
Calculated as total protein minus albumin; a rough measure of the antibodies and other globulins in the blood.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
Globulin: what is measured?
Globulin is not measured separately but calculated: total protein minus albumin. The number represents all proteins in the blood except albumin. That is a mixed group that includes transport proteins, inflammation proteins and antibodies (immune proteins or immunoglobulins). A change in globulin is often due to a change in the amount of antibodies.
What can it detect?
- More antibodies with long-lasting inflammation, an autoimmune disease or a chronic infection such as hepatitis
- Advanced liver disease (cirrhosis), in which globulin often rises and albumin falls
- Dehydration (albumin and globulin are then both somewhat higher)
- Rarely: an M-protein (one type of antibody in large amounts) or, on the contrary, a shortage of antibodies
Result
What does the result mean?
Globulin too high
A slightly raised globulin often has a temporary or harmless cause, such as dehydration after sweating or not drinking enough, or a recent infection. A clearly and persistently raised value fits long-lasting inflammation, an autoimmune disease such as rheumatoid arthritis, a chronic infection such as hepatitis B or C, or a liver disease. Rarely: an M-protein, one type of antibody that is made in large amounts, usually with MGUS (a condition without symptoms) and very occasionally with Kahler's disease (multiple myeloma). Exactly which proteins are raised can only be seen with protein electrophoresis.
Globulin too low
A slightly low globulin without symptoms usually has no significance. A lower value occurs with protein loss through the kidneys or the bowel, with severe malnutrition and with use of medicines that suppress the immune system, such as high-dose prednisone. Rarely: a shortage of antibodies, which often goes with recurrent infections, such as pneumonia or sinusitis.
After an abnormal result
With an abnormal globulin, the GP usually repeats total protein and albumin and looks at inflammation markers (CRP or ESR) and liver values. If the value stays clearly abnormal, protein electrophoresis or a measurement of the immunoglobulins follows and, if needed, a referral to the internist (specialist in internal medicine).
Reliability
How reliable is the test?
Globulin is a calculated value and adds nothing beyond total protein and albumin together; measurement errors in both values carry over into the calculation. The number does not tell which proteins are too high or too low. In practice, an abnormal value is investigated with protein electrophoresis or a measurement of the antibodies (immunoglobulins).
What can affect the result?
- Dehydration and a tourniquet left on for a long time during the blood draw raise total protein and albumin, and with them the calculated globulin.
- Laboratories measure albumin with different methods; the calculated value therefore differs per laboratory and there is no nationally agreed reference value.
- An infection or inflammation in the weeks before the blood draw can temporarily raise the value.
- Medicines that suppress the immune system can lower the value.
Who it is for
Who is the test useful for?
Useful for
The value is calculated automatically when total protein and albumin are measured, for example in an extensive panel for athletes, and is not a reason to test separately. As a rough indication, it can help when long-lasting inflammation, liver disease or frequently recurring infections are suspected, as a stepping stone to targeted testing. For healthy adults without symptoms, a single globulin value says little.
How common is it?
How often an abnormal globulin occurs in healthy adults is not known; most abnormalities are mild and temporary. An M-protein without symptoms (MGUS) occurs in about 3 in 100 people over 50 and in more than 7 in 100 people aged 70 and over. A severe shortage of antibodies is rare.
NVKC; Jeroen Bosch hospital (MGUS)
Drawbacks and risks
- A slightly abnormal calculated value often has no significance, but can lead to unnecessary worry and follow-up testing.
- Follow-up testing may find an M-protein without symptoms (MGUS), which needs no treatment but can lead to years of check-ups.
Get tested
Globulin: test panels
Globulin 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 results