prealbumin

pre·al·bu·min

(prē'al-byū'min),
1. A protein component of plasma having a molecular weight of about 55,000 and containing 1.3% carbohydrate; estimated plasma concentration is 0.3 g per 100 mL; abnormal levels of prealbumin are found in cases of familial amyloidosis. Synonym(s): transthyretin
2. The protein-containing zone observed in zone electrophoresis of serum that migrates more rapidly than serum albumin.

Prealbumin

Synonym/acronym: Transthyretin.

Common use

To assess nutritional status and evaluate liver function toward diagnosing disorders such as malnutrition and chronic renal failure.

Specimen

Serum (1 mL) collected in a gold-, red-, or red/gray-top tube.

Normal findings

(Method: Nephelometry)
AgeConventional UnitsSI Units (Conventional Units × 10)
Newborn–1 mo7–39 mg/dL70–390 mg/L
1–6 mo8–34 mg/dL80–340 mg/L
6 mo–4 yr2–36 mg/dL20–360 mg/L
5–6 yr12–30 mg/dL120–300 mg/L
7 yr–adult/older adult12–42 mg/dL120–420 mg/L

Description

Prealbumin is a protein primarily produced by the liver. It is the major transport protein for triiodothyronine and thyroxine. It is also important in the metabolism of retinol-binding protein, which is needed for transporting vitamin A (retinol). Prealbumin has a short biological half-life of 2 days. This makes it a good indicator of protein status and an excellent marker for malnutrition. Prealbumin is often measured simultaneously with transferrin and albumin.

This procedure is contraindicated for

    N/A

Indications

  • Evaluate nutritional status

Potential diagnosis

Increased in

  • Alcoholism (related to leakage of prealbumin from damaged hepatocytes and/or poor nutrition)
  • Chronic renal failure (related to rapid turnover of prealbumin, which reflects a perceived elevation in the presence of overall loss of other proteins that take longer to produce)
  • Patients receiving steroids (these drugs stimulate production of prealbumin)

Decreased in

    Acute-phase inflammatory response (prealbumin is a negative acute-phase reactant protein; levels decrease in the presence of inflammation) Diseases of the liver (related to decreased ability of the damaged liver to synthesize protein) Hepatic damage (related to decreased ability of the damaged liver to synthesize protein) Malnutrition (synthesis is decreased due to lack of proper diet) Tissue necrosis (prealbumin is a negative acute-phase reactant protein; levels decrease in the presence of inflammation)

Critical findings

    N/A

Interfering factors

  • Drugs that may increase prealbumin levels include anabolic steroids, anticonvulsants, danazol, oral contraceptives, prednisolone, prednisone, and propranolol.
  • Drugs that may decrease prealbumin levels include amiodarone and diethylstilbestrol.
  • Fasting 4 hr before specimen collection is highly recommended. Reference ranges are often based on fasting populations to provide some level of standardization for comparison. The presence of lipids in the blood may also interfere with the test method; fasting eliminates this potential source of error, especially if the patient has elevated lipid levels.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in assessing nutritional status.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s endocrine, gastrointestinal, and hepatobiliary systems; symptoms; and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Instruct the patient to fast for 4 hr before specimen collection.
  • Note that there are no fluid or medication restrictions, unless by medical direction.

Intratest

  • Potential complications: N/A
  • Ensure that the patient has complied with dietary restrictions; ensure that food has been restricted for at least 4 hr prior to the procedure.
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Instruct the patient to resume usual diet, as directed by the HCP.
  • Nutritional Considerations: Nutritional therapy may be indicated for patients with decreased prealbumin levels. Educate the patient, as appropriate, that good dietary sources of complete protein (containing all eight essential amino acids) include meat, fish, eggs, and dairy products and that good sources of incomplete protein (lacking one or more of the eight essential amino acids) include grains, nuts, legumes, vegetables, and seeds.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include albumin, chloride, ferritin, iron/TIBC, potassium, protein, sodium, T4, T3, transferrin, and vitamin A.
  • Refer to the Endocrine, Gastrointestinal, and Hepatobiliary systems tables at the end of the book for related tests by body system.

prealbumin

an electrophoretically fast-migrating protein in human serum but not positively identified in animals. Concerned in thyroxine binding and transport.
References in periodicals archive ?
C3, C4, Free Light Chains, Haptoglobin, IgA, IgE Specific, IgE Total, IgG, IgM, Immunofixation, Prealbumin, Protein Electrophoresis.
Wild juveniles had significantly lower concentrations of all protein fractions than wild adults, except for prealbumin and [gamma] globulins.
Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer.
The prealbumin level was reduced by 12%, consistent with acute phase reactions wherein the body directs efforts in making CRP and fibrinogen at the expense of making albumin and prealbumin.
Contract notice: Purchase of reagents for the determination of immunoglobulins and subclasses of igg, prealbumin, transferrin, crp.
2-Microbulin, Ceruloplasmin, CH50, Cystatin C, C3c, C4, Cl inactivator, Haptoglobin, IgA CSF, IgG CSF, IgM CSF, Prealbumin, Tetanus toxoid plasma screen (RUO), Transferrin
He reported a 38-pound weight loss, and serum prealbumin indicated protein malnutrition at 17 mg/dl.
Analysis of thyroid hormone binding to human serum prealbumin by 8-anilinonaphthalene-1-sulfonate fluorescence.
Proteinlerin SS'den kaybi albumin, seruloplazmin ve immunglobulinler (IgA, IgG, IgM) gibi yarilanma omru uzun olan proteinlerin plazma duzeyinde onemli dususlere neden olurken insulin, IgE, pihtilasma faktorleri, prealbumin ve transferin gibi yarilanma omru kisa olan proteinlerin duzeyinde onemli bir degisme olmaz (2).
Other commonly used nutritional parameters with short half-lives, such as retinol binding protein, transferin, and prealbumin were not assessed in our study due to the time gap between the patients' preoperative assessments and the date of their surgeries.
Patients had normal prealbumin values, indicating nutritional repletion of skeletal muscles and readiness to perform SBT.
Keep pressure off alarms prominence Lowest bed Site markings Incontinence care position Activate bed Anesthesia airway risk Nutritional screen, alarms prealbumin Teach patients Fluids and antibiotics started and families Equipment available?