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Patient Test Information

Prealbumin

  • Why Get Tested?

    Reasons for ordering the prealbumin test are undergoing reassessment as understanding of prealbumin is evolving. Historically, prealbumin has been ordered to help detect protein-calorie malnutrition and to monitor the effectiveness of parenteral (for example, intravenous) nutrition. Newer evidence suggests that the reasons for changes in prealbumin levels may be more complex and the test should not be interpreted as a simple indicator of nutritional status.

    When To Get Tested?

    No current consensus exists on when to get tested, although prealbumin may be ordered, along with assessments of nutritional intake, when a healthcare practitioner suspects that someone is malnourished or is at risk of malnutrition.

    Sample Required?

    A blood sample drawn from a vein in your arm

    Test Preparation Needed?

    None

  • What is being tested?

    Prealbumin, also called transthyretin, is one of the major proteins in the blood and is produced primarily by the liver. Its functions are to carry thyroxine (the main thyroid hormone) and vitamin A throughout the body. This test measures the level of prealbumin in the blood.

    Although commonly used as a marker of malnutrition, research is continuing in order to better understand the role(s) of prealbumin in the body, especially the reasons for changes observed during illness, and the clinical utility of prealbumin testing.

  • How is it used?

    Until recently, the prealbumin test was believed to be a useful marker of nutritional status and was used to help detect and diagnose protein-calorie malnutrition as well as to monitor people receiving total parenteral nutrition (TPN, getting nutrition via a solution injected into a vein). It was also used to monitor changes in nutritional status in someone undergoing hemodialysis as part of treatment for kidney disease.

    Some healthcare practitioners continue to use the test in this manner; however, there is controversy because changes in prealbumin may actually reflect other conditions such as inflammation, infection, or trauma. As such, it has been suggested by some health professionals that the prealbumin test should no longer be used to assess nutritional status or diagnose malnutrition. However, others believe that the test can be useful in determining prognosis for people who are critically ill, hospitalized, and/or at risk of poor outcomes and can prompt nutritional and other support that may improve patient outcomes.

    When is it ordered?

    With the caveats stated above, a prealbumin test may be ordered by some healthcare practitioners when signs and symptoms of malnutrition are present or when a person is felt to be at risk for malnutrition, such as during a critical or chronic illness, hospitalization, or when receiving parenteral nutrition or undergoing hemodialysis. It may also be ordered to aid in the determination of the severity of a patient's illness.

    What does the test result mean?

    Normal prealbumin levels vary according to age and sex.

    A low level of prealbumin may be seen with:

    • Malnutrition
    • Severe or chronic illness
    • Inflammation
    • Trauma, such as burns
    • Hyperthyroidism
    • Liver disease
    • Serious infections
    • Certain digestive disorders

    Given the ongoing discussion of the appropriate use of this test as researchers continue to explore the role of prealbumin in the body and what changes in its level in the body reflect, interpretation of prealbumin results is challenging. Some suggest that a single prealbumin result is less meaningful that a series of measurements taken several days apart, along with other clinical assessments and laboratory tests. For example, measures of inflammation, such as C-reactive protein (CRP), may be ordered to aid in interpretation of the prealbumin results.

    A high level of prealbumin may be seen in certain conditions, but the test is not used for diagnosis or monitoring in these situations.

    Is there anything else I should know?

    Drugs such as amiodarone, estrogens, and oral contraceptives (birth control pills) can decrease prealbumin levels. Anabolic steroids, androgens, prednisolone, and high-dose non-steroidal anti-inflammatory medications can increase prealbumin concentrations.

    Prealbumin levels can also be high in Hodgkin disease, kidney failure, iron deficiency, pregnancy, and with hyperactive adrenal glands.

    What is the difference between prealbumin, serum/plasma albumin, and urine albumin tests?

    Although the names are similar, prealbumin and albumin are completely different molecules. They are both proteins made by the liver, however, and both have been used historically to evaluate nutritional status. Serum/plasma (or blood) albumin is now more often used to screen for and help diagnose liver or kidney disease and is tested on a blood sample. The urine albumin test (in the past, called a microalbumin test) detects and measures albumin in the urine as an early indicator of kidney damage.

  • View Sources

    Sources Used in Current Review

    Shashidhar, H. and Grigsby, D. (2017 June 23, Updated). Malnutrition. Medscape Pediatrics: General Medicine. Available online at http://emedicine.medscape.com/article/985140-overview. Accessed on 6/25/17.

    Delgado, J. (2016 September, Updated). Proteins. ARUP Consult. Available online at https://arupconsult.com/content/proteins. Accessed on 6/25/17.

    (© 1995–2017). Prealbumin (PAB), Serum. Mayo Clinic Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9005. Accessed on 6/25/17.

    Bharadwaj, S et. al. (2016 May 11). Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep (Oxf). 2016 Nov; 4(4): 272–280. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193064/. Accessed on 6/25/17.

    Dawodu, S. et. al. (2015 August 13 Updated). Nutritional Management in the Rehabilitation Setting. Medscape Physical Medicine and Rehabilitation. Available online at http://emedicine.medscape.com/article/318180-overview#showall. Accessed on 6/25/17.

    Wang, W. et. al. (2017 February 1). Serum prealbumin and its changes over time are associated with mortality in acute kidney injury. Sci Rep. 2017; 7: 41493. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286447/. Accessed on 6/25/17.

    Sources Used in Previous Reviews

    The National Kidney Foundation: Kidney Disease Outcomes Quality Initiative. Available online at http://www.kidney.org/professionals/doqi/guidelines/nut_a04.html.

    Holland DC, Meers C, Lawlor ME, Lam M. Serial prealbumin levels as predictors of outcomes in a retrospective cohort of peritoneal and hemodialysis patients. Journal of Renal Nutrition, July 2001, 11(3).

    National Kidney Foundation Work Group, Committee: National Kidney Foundation-Kidney Disease Outcomes Quality Initiative. Clinical practice guidelines for nutrition in chronic renal failure. American Journal of Kidney Disease, June 2000, 35(6 Suppl 2): S1-140.

    Clinical Guide to Laboratory Tests. 3rd ed. Tietz N, ed. Philadelphia: W.B. Saunders & Co; 1995: 608-609.

    Frey RJ. Anorexia nervosa. Gale Encyclopedia of Medicine. Gale Research, 1999.

    Larry A. Broussard, PhD. Clinical Laboratory Sciences, LSU Health Sciences Center, New Orleans, LA.

    Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 755-756.

    Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 197.

    Banh, L. (2006 October). Serum Proteins as Markers of Nutrition: What Are We Treating? Practical Gastroenterology [On-line information]. PDF available for download at http://www.healthsystem.virginia.edu/internet/digestive-health/nutritionarticles/BanhArticle.pdf. Accessed June 2009.

    Huckleberry, Y. (2004 May 03). Nutritional Support and the Surgical Patient. Medscape Today from American Journal of Health-System Pharmacy [On-line information]. Available online at http://www.medscape.com/viewarticle/474066. Accessed June 2009.

    Beck, F. and Rosenthal, T. (2002 April 15). Prealbumin: A Marker for Nutritional Evaluation. American Family Physician [On-line information]. Available online at http://www.aafp.org/afp/20020415/1575.html. Accessed June 2009.

    Cassels, C. (2005 December 20). Hemodialysis, Prealbumin an independent predictor of mortality/morbidity. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/538923. Accessed June 2009.

    Johnson, A. (2007). Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clinical Chemistry and Laboratory Medicine. PDF available for download at http://www.ifcc.org/media/148186/CPP%20ClinChemLabMed%20200745419426.pdf. Accessed May 2013.

    Parrish, C.R. (2006). Serum Proteins as Markers of Nutrition: What are we treating? Nutrition Issues in Gastroenterology. PDF available for download through http://www.medicine.virginia.edu. Accessed May 2013.

    Shenkin A. Serum Prealbumin: Is It a Marker of Nutritional Status or of Risk of Malnutrition? Clin Chem Dec 2006 vol. 52 no. 12 2177-2179. Available online at http://www.clinchem.org/content/52/12/2177.full. Accessed March 2013.

    Beck F. Prealbumin: A Marker for Nutritional Evaluation. Am Fam Physician. 2002 Apr 15;65(8):1575-1579. Available online at http://www.aafp.org/afp/2002/0415/p1575.html. Accessed May 2013.

    Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, Pp 235-236.

    Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. 4th edition, St. Louis: Elsevier Saunders; 2006, Pg 563.

    Pagana and Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. Fourth edition. Pp. 424-427.

    Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). Jane V. White, PhD, RD, FADA; Peggi Guenter, PhD, RN; Gordon Jensen, MD, PhD, FASPEN; Ainsley Malone, MS, RD, CNSC; Marsha Schofield, MS, RD; the Academy Malnutrition Work Group; the A.S.P.E.N. Malnutrition Task Force; and the A.S.P.E.N. Board of Directors. J Acad Nutr Diet. 2012;112:730-738.