Lab

Serum Prealbumin

search

Serum Prealbumin, Prealbumin

  • Indications
  1. Malnutrition Evaluation (See Malnutrition Labs)
  2. Monitoring of nutritional improvement
  • Efficacy
  1. Correlates with clinical outcomes
  2. Prealbumin is the best marker of Malnutrition
    1. Short serum half-life
    2. Less affect by liver disease than other proteins
    3. Not affected by hydration status
    4. Not affected by Vitamin Deficiency (except zinc)
  • Pathophysiology
  1. Serum half-life: 2 days
  2. High essential to nonessential amino acid ratio
  3. Production
    1. Liver is primary source
    2. Other sites of production
      1. Choroid plexus
      2. Enterochromaffin cells in gastrointestinal mucosa
  • Normal
  1. Prealbumin: 16 to 35 mg/dl
  • Increased Serum Prealbumin
  1. Alcohol Abuse (especially binge drinking)
    1. Prealbumin returns to baseline after 7 days
  2. Medications
    1. Corticosteroids (e.g. Prednisone)
    2. Progesterone and related agents
  • Decreased Serum Prealbumin
  1. Protein Malnutrition
  2. Other Causes
    1. Zinc Deficiency
    2. Negative acute phase reactant
      1. Decreases with inflammation or post-surgery
  • Interpretation in Malnutrition
  1. Protein Malnutrition Diagnosis
    1. Prealbumin <5 mg/dl: Predicts poor prognosis
    2. Prealbumin <11 mg/dl: High risk
      1. Requires aggressive Nutritional Supplementation
    3. Prealbumin <15: Increased risk of Malnutrition
      1. Monitoring recommended twice weekly
    4. Reference
      1. Bernstein (1995) Nutrition 11:170 [PubMed]
  2. Protein Malnutrition Monitoring
    1. Findings suggestive of adequate nutritional support
      1. Prealbumin level rising 2 mg/dl per day
      2. Prealbumin level returns to normal by 8 days
    2. Findings requiring intense nutritional (e.g. TPN)
      1. Prealbumin level rises <4 mg/dl in 8 days