Total Protein

Total protein includes albumin and globulin. The factors that affect the total protein level include changes in fluid status, the balance of protein synthesis and catabolism, and protein losses. While dehydration can cause a relative increase in serum protein concentration, volume expansion causes a relative decrease in protein concentration. Elevated protein levels in the absence of dehydration are usually related to increased globulin levels. As previously discussed, acute-phase reactants are proteins that are increased in inflammatory conditions and include C-reactive protein, haptoglobin, fibrinogen, ceru-loplasmin, and a1-antitrypsin.

Table 15-21 Noncancer Factors that May Influence Prostate-Specific Antigen

Factor

Change

Acute urinary retention

Increase

Androgens

Increase

Antiandrogens

Decrease

Bed rest

Decrease

Benign prostatic hypertrophy

Increase

Cirrhosis

Increase

Cystoscopy

Increase

Digital rectal examination

Not significant

Diurnal variation

No change

Ejaculation

Increase

Extensive exercise

Increase

Finasteride

Decrease

Physiologic variation

May fluctuate by 30%

Prostate needle biopsy

Increase

Prostatic massage

Increase

Prostatitis

Increase

Radial prostatectomy

Decrease

Radiation therapy

Increase initially then decrease

Transurethral resection of prostrate

Increase

Transurethral ultrasound of prostrate

No change

Urethral instrumentation

Increase

Serum protein electrophoresis separates proteins based on their mobility in an electric field and can provide a visual estimate of albumin and globin levels. The five bands on the electrophoresis column include albumin, a1-globulin, a2-globulin, p-globulin, and y-globulin. The main component of the a1 band is a antitrypsin, which may increase with pregnancy, estrogen therapy, and inflammation. a2-Globulin is composed of haptoglobin, ceruloplasmin, and a2-macroglobulin. The main component of p-globulin is transferrin, which functions to transport iron. Transferrin levels are reduced in liver disease, nephrotic syndrome, protein-losing enteropathy, and starvation. Levels of trans-ferrin are helpful in monitoring nutritional status in hospitalized patients. Elevations may be seen in iron deficiency anemia, pregnancy, and estrogen use. The p-lipoprotein band can be found in the a2-globulin or p-globulin zone. The immunoglobulins are found primarily in the y region. Diffuse elevations in the y region can occur with chronic infections, liver disease, autoimmune disorders, and gran-ulomatous diseases. A monoclonal spike in the y region indicates proliferation of a single immunoglobulin, as

Table 15-22 Positive Predictive Value (PPV) of Total Prostate-Specific Antigen (PSA) for Prostate Cancer

Digital Rectal Examination

PSA Value

0.0-4.0 ng/mL

4.1-10 ng/mL

>10 ng/mL

Negative

9%

20%

31%

Positive

17%

45%

77%

Data from Oesterling JE. Prostate-specific antigen: 1991;5:112.

a valuable clinical

tool. Oncology

seen in myeloma or a monoclonal gammopathy of uncertain significance. Immunoglobulin abnormalities noted on protein electrophoresis can be further characterized by immunoelectrophoresis.

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