Understanding of the tests available provides the physician with useful diagnostic tools. The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level.
Our aim is to help you consider how to deliver improvements to healthcare within the available resources. This CPD activity consists of 5 multiple-choice questions MCQs designed to test your knowledge on plasma protein testing. Dr Jez Thompson highlights the key recommendations from the British Society of Gastroenterology on liver blood tests and early detection of liver disease. This CPD activity consists of 5 multiple-choice questions MCQs designed to test your knowledge on liver blood tests—you will then be prompted to reflect on your learning.
This CPD activity consists of 5 multiple-choice questions MCQs designed to test your knowledge on primary biliary cholangitis PBC in primary care—you will then be prompted to reflect on your learning. Dr Jez Thompson discusses the European Association for the Study of the Liver guideline on diagnosis and management of patients with this progressive, long-term condition. Site powered by Webvision Cloud. Skip to main content Skip to navigation. Liver disease.
No comments. Dr Jez Thompson. Box 1: Plasma protein measurement in practice 9 A GP may request measurement of plasma protein when: investigating a specific symptom, such as peripheral oedema diagnosing an inflammatory process or autoimmune disorder for example, antinuclear antibody testing in the assessment of systemic lupus erythematosus [SLE] diagnosing bone marrow disorders, including multiple myeloma assessing allergies testing for immunodeficiency in patients with recurrent infections assessing immunity to infections, such as hepatitis B or rubella, through specific antibody assays investigating possible coeliac disease through the measurement of total immunoglobulin A IgA and IgA tissue transglutaminase antibody.
Create an online pathology handbook and clinical algorithm tool that can be accessed by all clinicians who request blood sampling: list available tests with the indications for ordering them and guides to interpretation of results link the handbook to any online electronic pathology ordering system that is used in the STP area define any required tests in referral management systems and if possible link these electronically to the handbook Audit and monitor requests for pathology samples to check these are being made appropriately and represent an efficient use of resources.
Topics Haematological conditions Liver disease Renal conditions. Related articles. Test and reflect Best practice in interpreting plasma protein tests TZ This CPD activity consists of 5 multiple-choice questions MCQs designed to test your knowledge on plasma protein testing.
Implementing guidelines Liver blood tests: how to interpret abnormal results TZ Dr Jez Thompson highlights the key recommendations from the British Society of Gastroenterology on liver blood tests and early detection of liver disease.
Implementing guidelines Identify chronic kidney disease early to minimise renal decline TZ Dr Patrick Holmes reviews the recommendations of NICE Guideline , Chronic kidney disease: assessment and management. Load more articles. No comments yet. Just as there are different types of globulins, there are different types of globulin tests.
These include:. Your health care provider may order globulin tests as part your regular checkup or to help diagnose specific conditions. A total protein test may be included in a series of tests to check how well your liver is working. These tests, called liver function tests, may be ordered if you are at risk for liver disease or have symptoms of liver disease, which may include:.
A serum protein electrophoresis test measures gamma globulins and other proteins. This test may be ordered to diagnose disorders related to the immune system , including:. Globulin tests are blood tests. During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial.
You may feel a little sting when the needle goes in or out. This usually takes less than five minutes. You don't need any special preparations for a globulin test. If your health care provider has also ordered other blood tests, you may need to fast not eat or drink for several hours before the test.
Your health care provider will let you know if there are any special instructions to follow. Where the gamma fraction is increased, it can then be further established whether this is a narrow spike-like increase of a single immunoglobulin a monoclonal rise or a broader-based increase polyclonal rise.
Monoclonal rises are then further evaluated with immunoelectrophoresis or immunofixation electrophoresis see below. Monoclonal spikes are more likely to have a malignant cause, with multiple myeloma being the most common of these.
However, the most common cause of a monoclonal rise is monoclonal gammopathy of uncertain significance MGUS which is usually a benign condition. Abnormal immunoglobulins produced in excess monoclonally are also known as paraproteins. Immunoelectrophoresis or immunofixation electrophoresis is usually performed when SPEP has found the presence of increased gammaglobulin levels in order to further establish the nature of the abnormality.
It identifies the type of gammaglobulin. This is commonly used in the diagnosis of myeloma. Causes of raised immunoglobulin levels Electrophoresis will establish if these are polyclonal or monoclonal rises. The most common rise in immunoglobulin levels is polyclonal, and due to immune system activity caused by infection or autoimmune diseases.
Blood tests can be done which measure the amount of IgE antibodies which have been produced in response to specific allergens. Blood allergy tests are more expensive and less sensitive than skin prick testing, but can be useful in certain situations - for example, when there is a risk of anaphylaxis, or severe skin rashes, or when the patient needs to continue taking antihistamines. Hundreds of different allergens can be tested for in this way. A raised globulin level may be a relatively common coincidental finding.
The work-up to establish the cause involves history, examination and further investigations to determine which of the conditions listed above may be causing the abnormality. One possible answer is that increased production of immunoglobulins is linked with inflammation ; inflammatory factors like c-reactive protein and IL-6, for example, increase immunoglobulins [ 12 ].
Inflammation also rises with aging, which could explain why older people with higher gamma gaps were more likely to die than those with lower gamma gaps. The most important thing is to work with your doctor to treat any underlying conditions causing your high globulin levels. The additional strategies below are other things that you may try if you and your doctor determine that they could be appropriate.
Exercise more often. Both aerobic and strength exercise may help significantly decrease globulin levels in people [ 14 ]. In both men and women, more days per week of either aerobic or strength exercise were significantly associated with lower globulin [ 14 ]. You may also need to stop taking protein supplements, as these may be causing higher protein and globulin levels [ 15 ]. Drink more water to prevent dehydration [ 2 , 16 ]. Zinc may help prevent dehydration due to diarrhea, according to limited studies [ 17 ].
Electrolytes can also help with dehydration due to diarrhea [ 18 ]. Limit alcohol intake; alcohol can worsen dehydration [ 19 ]. Try to reduce stress, since acute stress may increase certain types of globulins [ 20 ].
The conditions we discuss here are commonly associated with low globulin, but this single symptom is not enough for a diagnosis. Work with your doctor to discover what underlying condition might be causing low globulin levels and to develop an appropriate plan to improve your health. The most important thing is to work with your doctor to treat any underlying conditions causing your low globulin levels.
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