1. Total Proteins & Albumin Analysis
Lab. 3

2. Introduction
The key roles which plasma proteins play in bodily function, together with the relative ease of assaying them, makes their determination a valuable diagnostic tool as well as a way to monitor clinical progress.
In very general terms, variations in plasma protein concentrations can be due to any of three changes:
in the rate of protein synthesis,
the rate of removal,
and in the volume of distribution.
M. Zaharna Clin. Chem. Lab. 2009

3. Proteins: Common properties
In spite of functional differences between the various serum proteins, they have certain common biophysical and biochemical properties. These include:
a basic composition of carbon, hydrogen, nitrogen and oxygen;
a backbone of covalent peptide bonds which join the amino acid units together; and
absorption maxima in the ultraviolet region.
Based on these properties, laboratory methods have been developed to determine the concentration of proteins in serum often with the assumption that:
each of the several hundred individual proteins present in serum reacts similarly in chemical reactions.
M. Zaharna Clin. Chem. Lab. 2009

4. Serum Total Protein
Serum total protein, also called plasma total protein or total protein, is a biochemical test for measuring the total amount of protein in blood plasma or serum.
Protein in the plasma is made up of albumin and globulins.
The globulin in turn is made up of α1, α2, β, and γ globulins.
These fractions can be quantitated using protein electrophoresis, but the total protein test is a faster and cheaper test that estimates the total of all fractions together.
The traditional method for measuring total protein uses the biuret reagent, but other chemical methods are also available.
M. Zaharna Clin. Chem. Lab. 2009

5. Methods of Total Protein Analysis
Method 1: Kjeldahl; quantitative, protein nitrogen determination
Method 2: Ultraviolet absorption; quantitative, absorption at 210 nm
Method 3: refractometry; quantitative, RI
Method 4: Biuret; quantitative, increased absorption at 540 nm;
M. Zaharna Clin. Chem. Lab. 2009

6. Specimen
Serum and plasma may be used, and all usually yield comparable results, though, because of the presence of fibrinogen, plasma levels for total protein are 2 to 4 g/L higher than serum levels.
A fasting specimen is not required but may be desirable to decrease lipemia.
Total protein is stable in serum and plasma for
1 week at room temperature,
and for at least 2 months at –20° C
M. Zaharna Clin. Chem. Lab. 2009

7. The concentration of proteins in plasma is affected by posture: an increase in concentration of 10-20% occurs within 30 minutes of becoming upright after a period of recumbency.
Also, if a tourniquet is applied before veinpuncture, a significant rise in protein concentration can occur within a few minutes.
In both cases, the change in protein concentration is caused by increased diffusion of fluid from the vascular into the interstitial compartment.
These effects must be borne in mind when blood is being drawn for the determination of protein concentration.
M. Zaharna Clin. Chem. Lab. 2009

8. Hypoproteinemia Hyperproteinemia Malnutrition and/or malabsorption
Excessive loss as in renal disease, GI leakage,
excessive bleeding, severe burns
Excessive catabolism
Liver disease
Hyperproteinemia
Dehydration
Monoclonal increase
Polyclonal increase
Only disorders affecting the concentration of albumin and/or the immunoglobulins will give rise to abnormal total protein levels.
Other serum proteins are never present in high enough concentrations for changes to have a significant overall effect.
M. Zaharna Clin. Chem. Lab. 2009

9. The Biuret Method
The Biuret reagent is made of (NaOH) and copper (II) sulfate (CuSO4), together with potassium sodium tartrate (KNaC4H4O6).
A blue reagent which turns violet in the presence of proteins,
The Sodium hydroxide does not participate in the reaction at all, but is merely there to provide an alkaline medium so that the reaction can take place.
M. Zaharna Clin. Chem. Lab. 2009

10. Principle: Biuret Method
Peptide bonds of proteins react with tartrate-complexed cupric ions in alkaline solutions to form a colored product.
In a positive test, a copper(II) ion is reduced to copper(I), which forms a complex with the nitrogens and carbons of the peptide bonds in an alkaline solution.
A violet color indicates the presence of proteins.
It is possible to use the Biuret reaction to determine the concentration of proteins because (for most proteins) peptide bonds occur with approximately the same frequency per gram of material.
The intensity of the color, and hence the absorption at 540 nm, is directly proportional to the protein concentration, and can be determined spectrophotometrically at 540 nm.
M. Zaharna Clin. Chem. Lab. 2009

11. M. Zaharna Clin. Chem. Lab. 2009

12. Reference range Reference range for total proteins is 66.6 to 81.4 g/L
Results for males are approximately 1 g/L higher than results for females; this difference is probably not of clinical significance.
In newborns, the mean serum protein concentration is 57 g/L, increasing to 60 g/L by 6 months and to adult levels by about 3 years of age.
M. Zaharna Clin. Chem. Lab. 2009

13. Albumin
Albumin is the most abundant circulating plasma protein (40–60 % of the total)
Playing important roles in the maintenance of the colloid osmotic pressure of the blood, in transport of various ions, acids, and hormones.
It is a globular protein with a molecular weight of approximately 66,000 D and is unique among major plasma proteins in containing no carbohydrate.
It has a relatively low content of tryptophan and is an anion at pH 7.4.
These properties have been exploited in the estimation of albumin in body fluids.
M. Zaharna Clin. Chem. Lab. 2009

14. Analysis Methods Method 1: Precipitation; quantitative
Salt fractionation, Solvent fractionation, Acid fractionation
Principle of analysis: Changes of net charge of protein result in precipitation
Method 2: Tryptophan content; quantitative
Principle of analysis:
Glyoxylic acid + tryptophan in globulin Purple chromogen (Amax, 540 nm); Total protein – globulin = albumin.
Method 3: Electrophoresis; quantitative
Principle of analysis: Albumin is separated from other proteins in electrical field; percent staining of albumin fraction multiplied by total protein value
M. Zaharna Clin. Chem. Lab. 2009

15. Analysis Methods Method 4: Immunochemical
Radial immunodiffusion; Turbidimetry; Nephelometry; Radioimmunoassay; Enzyme immunoassay;
Method 5: Dye binding, quantitative
Methyl orange; BCG (bromcresol green); BCP (bromcresol purple);
Method 6: Dye binding; semiquantitative
Bromphenol blue in test strip changes color from yellow to blue in presence of albumin most commonly used test for urine protein
M. Zaharna Clin. Chem. Lab. 2009

16. Specimen Serum is the specimen of choice
Fasting is not required, although it may be desirable since marked lipemia interferes in the BCG assay.
Venostasis should be avoided when collecting samples since hemoconcentration increases the apparent concentrations of albumin and other plasma proteins.
M. Zaharna Clin. Chem. Lab. 2009

17. Albumin Reference Interval for Serum
Interfering Factors
Albumin is decreased in:
Pregnancy (last trimester, owing to increased plasma volume)
Oral birth control (estrogens) and other drugs
Prolonged bed rest
IV fluids, rapid hydration, overhydration
Albumin Reference Interval for Serum
Age
Men (g/L)
Women (g/L)
21–44
33.3–61.2
27.8–56.5
M. Zaharna Clin. Chem. Lab. 2009

18. Clinical Significance
Plasma albumin levels, although important for management and follow-up, have very little value in clinical diagnosis.
Hyperalbuminemia is usually attributable to:
dehydration or hemoconcentration.
Hypoalbuminemia is usually the result of
hemodilution,
a rate of synthesis less than the albumin loss,
diseases that cause a large albumin loss from urine, skin, or intestine,
and increased catabolism observed in fevers, untreated diabetes mellitus, and hyperthyroidism.
M. Zaharna Clin. Chem. Lab. 2009

19. Dye-binding Techniques
Serum albumin is most often assayed using dye-binding techniques.
Albumin preferentially binds to anionic dyes that do not attract globulins
Bromcresol purple (BCP) and bromcresol green (BCG) are most commonly used
The amount of light absorbed by the albumin –dye complex is proportional to the amount of albumin present
M. Zaharna Clin. Chem. Lab. 2009

20. BCG + Albumin BCG-albumin complex
Bromcresol Green
Principle
BCG complexes with albumin, resulting in the dye having a spectral shift
The presence of albumin increases the absorbance at 546 nm which is determined spectrophotometrically
pH 4.3
BCG + Albumin BCG-albumin complex
M. Zaharna Clin. Chem. Lab. 2009