Prealbumin Test

The prealbumin test is used to help your doctor diagnose problems with your nutrition. Prealbumin is most often used to help doctors diagnose 'protein-calorie' malnutrition. In this condition, which can affect more than 30% of hospitalised patients, the body breaks down muscle, protein, and body fat. This type of malnutrition can lead to complications and even death if not treated. Children with malnutrition may be unwell or have stunted growth.

The test is also used to make an assessment of nutritional status:

• before a scheduled operation,
• in patients who are hospitalised with certain conditions, and
• in patients who have been ill for a long period of time.

Many patients have a decline in nutrition during their hospital stay, especially after surgery. Studies have shown that good nutrition prior to surgery helps to avoid complications, such as pneumonia and infection, after surgery. If the prealbumin test suggests that you are malnourished or have poor nutrition, your doctor can help correct your diet so you get stronger before your surgery. Albumin may be tested instead to determine nutritional status.

The test is also used to monitor changes in patients who are receiving nutrition support such as parenteral nutrition (nutrition from outside of the gastrointestinal tract, such as nutrients given directly into a vein through a drip). The test is also used to monitor changes in nutritional status for patients who are receiving haemodialysis, a process that removes waste substances from your circulating blood. Haemodialysis is part of treatment for patients with kidney disease.

A doctor may use a prealbumin test when signs of malnutrition or poor nutrition are present. Signs of malnutrition include extreme weight loss, stunted growth (in a child), weakened resistance to infection, or being unable to think clearly. Hair may become brittle or begin to fall out, the skin may be dry or yellowish, muscles may feel weak, and fainting spells may occur. In younger women, menstrual periods may stop.

A prealbumin or albumin test will be used before surgery or when a patient is being treated for certain conditions. Doctors may also use the test regularly to monitor patients who have had low prealbumin results.

The prealbumin measurement may reflect the state of your nutrition. If prealbumin is low, other proteins and substances in your blood may also be low.

If your test shows that prealbumin is low, your nutrition may need to be corrected. If prealbumin is very low, you may be considered malnourished and need immediate medical attention. Lower levels of prealbumin may be seen in patients with:

• severe or long-term illness, such as cancer
• hyperthyroidism
• liver disease
• serious infections
• certain digestive disorders

If a patient has Inflammation, however, it is impossible to know exactly what the prealbumin value means. When inflammation and malnutrition are both present, prealbumin levels fall very far, very quickly. When the prealbumin level is low it can be difficult for the doctor to know whether this is as a result of malnutrition, illness or both.  This problem considerable limits the usefulness of the prealbumin test.

Higher levels of prealbumin are common in patients with:

• high-dose corticosteroid therapy;
• hyperactive adrenal glands;
• high-dose nonsteroidal anti-inflammatory medications; and
• Hodgkin's disease

If a patient has kidney failure, prealbumin results may be falsely higher than they actually are.

Inflammation can interfere with the results of your prealbumin test, causing it to be lower than it would be. Certain drugs can also lower your prealbumin level, including amiodarone, oestrogens, and oral contraceptives (the pill).

Drugs that can cause your prealbumin level to rise in your blood are anabolic steroids, androgens (male hormones), and prednisolone.

Recent research has shown that the prealbumin test can predict poor outcomes for haemodialysis patients. A low initial reading (baseline level) of prealbumin predicts that a patient may have problems, and steadily dropping prealbumin values are associated with low survival. The prealbumin test is not widely used in the UK, and albumin may be measured instead.