Let's talk about lab values, we'll
talk about that as an option.
And I will talk about key
lab values for the GI system.
Serum albumin and prealbumin,
you'll see most often but
I also want to introduce you to transferrin
if you have not been introduced to that yet.
Let's start with the first one, serum albumin.
Now have you stopped to think What
does albumin represent in your body?
I just happen to have the answer for you.
Now what serum albumin represents
in your body is protein,
because see, a healthy liver, even
one that is a geriatric liver,
transforms the protein that you ingest
into albumin, so it takes what you eat.
Remember, you've got those massive
vessels that come up from your intestines,
back up to your liver, there it can
transform the protein that you eat,
and turn it into albumin.
We measure that on a lab
test called serum albumin.
Remember, lab work is drawn right from a vein,
a serum albumin would be drawn from a vein.
And that's what we're measuring
when we say serum albumin.
So the protein doesn't matter
if the source is animal.
So if you're sitting down to a big steak, or
if it's a plant source of protein - same thing.
A healthy liver is going to turn the protein
that you eat into albumin in your blood.
And it does some amazing things like serum albumin
is charged in a way that it will
attract sodium, and albumin -
it's this really big thing that's not
meant to go through the capillary.
So it should stay in your intravascular space
and draw the appropriate amount of fluids
into your intravascular space.
That way you can maintain
an adequate blood pressure.
So serum albumin does let us know about
nutritional intake and how the liver's doing
but it also is going to impact their fluid
volume bowel, so it's really important.
So you see there, we did that you took
the protein in and you watch the liver,
turn it into albumin just to
reinforce that concept in your mind.
Now, if the liver isn't functioning
correctly, you'll notice on our graphics,
just the look of the liver changes, right,
we did that to kind of help you recognize
this is when the liver isn't fully functioning
or not functioning as well as it could.
If the liver isn't functioning well, it would
make sense that it can't turn that protein
into albumin as efficiently
as a healthy liver can.
So you're likely going to see
a decrease in serum albumin.
So if I'm working with a client, and I look
at their serum albumin level, and it is low,
I always want to think, 'Ah, wonder
if they're showing me any other signs
that they could have a problem with their liver.
So that's why a health care
provider could order this test.
They either are trying to assess the livers ability
to take dietary protein and turn it into albumin
and also be a lab work that they draw if
the client has that unexpected weight loss.
Remember, we're always looking at
the trend of a patient's weight,
not judging them if they're under or over.
We're looking at the trend of their weight
and if they've had a change in their weight,
they've lost weight, and they
have a lower serum albumin,
we know we need to investigate even further.
We've put the normal value, the ranges
for serum albumin on the screen.
I don't want you to get so focused on the numbers.
They're just there as a reference and keep
in mind depends on where you're practicing ,
what country you're practicing in,
which lab is doing the lab work
as to what will be the normal range.
But whenever you get your lab work
back, that laboratory will report
what they see as a normal range.
Keep in mind, these are going to vary
from lab to hospital to different place.
So, you may even have some different units.
We've just put up some examples of what you
might expect for a normal serum albumin range.
Now, prealbumin was the second one
and I want to talk to you about
what prealbumin represents in your body.
Now, pre albumin is a protein, well, that's
going to be easy to remember because we knew
albumin is a protein, so
prealbumin is also a protein.
And it's also made in your liver.
So both prealbumin and albumin
are made in your liver.
Now, what prealbumin does that's a little
different is it helps carry thyroid hormones,
and vitamin A through your bloodstream.
Whoa, okay, that's different
than serum albumin, right?
Because we talked about the way a serum albumin
is, it's charged in a way that attracts sodium
and then you've got water that
comes into your intravascular space.
But prealbumins job is a little
different, and that's why we have it,
because its job is to carry thyroid hormones,
and vitamin A through your bloodstream.
So what can we learn from a patient?
Well, before we talk about that, look, as you
see the animation we here have for you here.
So you can kind of understand
how prealbumin works.
So the obvious question is, why would a
healthcare provider order a pre albumin test?
Well, a pre albumin test is going to give us
a little more information about the patient's
recent nutritional status.
Albumin encompasses a longer
period of time, but prealbumin
tells me what's gone on most
recently with this patient.
So they're going to look if they
need that particular information.
That's why they would order a prealbumin test.
Now, some signs that you may have seen,
some cues is when you weighed the patient,
and then you recognize the patient had
experienced unexpected weight loss.
Health care providers likely
to order a prealbumin.
Now, if the scores come back outside of the normal
range, let's talk about high prealbumin scores.
This tells us we have another problem.
Now, it could be a sign of long
term chronic kidney disease.
The patient may or may not know that they have it.
But we know we're going to work through
these diagnoses and see if the patient
has any other indicators of kidney disease,
steroid use or maybe something like alcoholism.
Now there are several other
causes of a high prealbumin score.
We just narrowed it down to
these three to kind of give you
three most important that will stick in your mind.
We've got a normal range
there for you on the screen.
Remember what we always say,
ranges can vary by laboratory
and you may use a different type
of unit where you're practicing.
So be sure to check your protocols.
So let's go back to what is the difference
between prealbumin and albumin serum tests.
I'm going to pause for a minute
because I know you can answer this.
Okay, let's break it down and see how much
you're able to remember and get correct.
Prealbumin is a precursor to albumin,
so that means it comes before albumin.
Now, it's a really good marker of your protein
status, specifically, your visceral protein status.
Now, this is affected earlier by acute
changes in your protein balance.
This is going to let us know what's
gone on in the previous week. Right?
Because its half-life is like 2 to 4 days.
So are prealbumin and albumin related?
Do they have different jobs?
Albumin is a precursor, right?
Prealbumin is a precursor to albumin.
That's why those three letters -
PRE, make it very easy to remember.
Now we can use an albumin test and they say, it's
often used as a surrogate marker of nutrition.
So it's not the worst test for knowing
what their nutritional status is.
But it's not as good as telling
about what's happened recently.
Because look at the half life
of albumin, it's 21 days.
Well, the half life of prealbumin is 2 to 4 days.
Because prealbumin doesn't
stick around as long as albumin,
then we know that we'll know much
more information about what's happened
recently as far as nutrition versus the longer
period of time with the half life of 21 days.
So it's not as valuable if I'm wanting to
find out what has happened most recently.
Now why have we repeated that multiple times?
Because it's really an important concept.
Albumin is a very prominent protein in your body,
you need to understand and be able to recognize
the differences and the similarities
between prealbumin and albumin
and what information we get from the lab test.