Lab result explainedLiverLast updated November 8, 2026

Globulin blood test: what high and low globulin and the albumin/globulin ratio mean

Globulin and albumin/globulin ratio · Comprehensive metabolic panel (calculated from total protein and albumin); serum protein electrophoresis · reported in g/dL (g/L outside the US; 1 g/dL = 10 g/L); A/G ratio has no units

Globulin is the collective name for all the proteins in your blood that are not albumin. On a standard metabolic panel it is not measured directly: the lab measures total protein and albumin and subtracts one from the other, so globulin = total protein − albumin. A normal globulin is about 2.0 to 3.5 g/dL. The albumin-to-globulin (A/G) ratio divides one by the other; a normal ratio is roughly 1.1 to 2.5, meaning there is a little more albumin than globulin.

The globulin fraction is a mixture. Alpha and beta globulins include transport and clotting proteins (transferrin, haptoglobin, alpha-1 antitrypsin, complement). The largest and most variable component is the gamma globulins, which are your antibodies (IgG, IgA, IgM). Because of this, globulin rises with anything that stimulates antibody production over weeks: chronic infections such as hepatitis or HIV, autoimmune diseases such as rheumatoid arthritis and lupus, chronic liver disease, and, importantly, plasma cell disorders such as multiple myeloma and its precursor MGUS, where a single abnormal antibody is produced in bulk.

A low globulin usually means too few antibodies, from an inherited or acquired immune deficiency, from medications such as steroids or rituximab, or from protein loss through the kidneys or gut. The A/G ratio adds a second lens: a low ratio (under about 1.0) can come from either a low albumin or a high globulin and is a prompt to look at both; a high ratio usually reflects a low globulin. A globulin above about 4 g/dL or a ratio under 1.0 is the usual trigger for a serum protein electrophoresis, which separates the globulins and shows whether a rise is polyclonal (many antibodies, meaning infection or inflammation) or monoclonal (one antibody, meaning a plasma cell disorder).

Globulin and albumin/globulin ratio at a glance

  • What it is: all blood proteins other than albumin, calculated as total protein − albumin; mostly antibodies (gamma globulins) plus transport, clotting and complement proteins.
  • Normal: globulin 2.0–3.5 g/dL (some labs 2.3–3.5); total protein 6.0–8.3 g/dL; A/G ratio about 1.1–2.5 (some labs quote 1.0–2.2). Labs differ.
  • High globulin (above 3.5): chronic infection, autoimmune disease, chronic liver disease, multiple myeloma or MGUS, lymphoma, dehydration. Above about 4 g/dL prompts protein electrophoresis.
  • Low globulin (below 2.0): immune deficiency, steroids or immune-suppressing drugs, kidney or gut protein loss, malnutrition, some leukemias.
  • Low A/G ratio (under 1.0): either low albumin (liver disease, inflammation, kidney loss) or high globulin; high A/G ratio usually means low globulin.
  • Next step: read with albumin, CRP, liver tests and a serum protein electrophoresis with immunoglobulin levels and free light chains if globulin is high or the ratio is low.

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What Globulin and albumin/globulin ratio measures

Blood plasma contains about 7 g/dL of protein. Roughly 60 percent is albumin and the remaining 40 percent is globulin. On a metabolic panel the lab measures total protein with a chemical (biuret) method and albumin with a dye-binding method, then reports globulin as the difference and the A/G ratio as albumin divided by globulin. Because globulin is a derived number, an error or shift in either measurement changes it, and a low albumin automatically produces a low A/G ratio even when globulin is perfectly normal.

Serum protein electrophoresis (SPEP) separates the globulins by electrical charge into four bands. Alpha-1 globulins (about 0.1–0.3 g/dL) are mainly alpha-1 antitrypsin, which rises in inflammation and is low in alpha-1 antitrypsin deficiency. Alpha-2 globulins (0.6–1.0 g/dL) include haptoglobin, ceruloplasmin and alpha-2 macroglobulin, which rise in inflammation and in nephrotic syndrome. Beta globulins (0.7–1.2 g/dL) include transferrin, complement C3 and the proteins of LDL cholesterol. Gamma globulins (0.7–1.6 g/dL) are the immunoglobulins: IgG (normally about 700–1,600 mg/dL), IgA (70–400 mg/dL) and IgM (40–230 mg/dL).

The pattern on electrophoresis is what matters when globulin is high. A broad, smooth increase in the gamma region (polyclonal) means many different plasma cells are making antibodies, as in chronic infection, autoimmune disease or cirrhosis. A sharp narrow spike (a monoclonal or M protein) means one clone of plasma cells is producing a single antibody, which is the hallmark of multiple myeloma, MGUS, Waldenström macroglobulinemia, amyloidosis and some lymphomas. Immunofixation identifies which antibody type it is, and serum free light chains detect clones that produce only antibody fragments. Globulin is not a fasting test, but dehydration concentrates it.

Normal range for Globulin and albumin/globulin ratio

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

GroupTypical range (g/dL (g/L outside the US; 1 g/dL = 10 g/L); A/G ratio has no units)Notes
Globulin, adults2.0–3.5 g/dLSome labs use 2.3–3.5 or 1.9–3.7 g/dL. Equivalent to 20–35 g/L. Labs differ; use the printed range.
Total protein, adults6.0–8.3 g/dLGlobulin is total protein minus albumin; both source values are on your report.
A/G ratio, normalAbout 1.1–2.5Some labs quote 1.0–2.2 or 1.2–2.2. Slightly more albumin than globulin is normal.
A/G ratio, lowBelow 1.0Either albumin is low (inflammation, liver disease, kidney or gut loss) or globulin is high (chronic infection, autoimmune disease, myeloma). Look at both values.
A/G ratio, highAbove about 2.5Usually a low globulin (immune deficiency, steroids, immune-suppressing drugs); occasionally a high albumin from dehydration.
Mildly raised globulin3.6–4.0 g/dLOften a polyclonal rise from chronic infection, inflammation or liver disease, or mild dehydration; repeated and read with CRP and liver tests.
Raised globulinAbove 4.0 g/dLUsual threshold for serum protein electrophoresis, immunoglobulin levels and free light chains to look for a monoclonal protein.
Monoclonal (M) protein on electrophoresisBelow 3 g/dL with no organ damage: MGUS; 3 g/dL or more, or any level with bone, kidney, calcium or blood count damage: myeloma or related disorderMGUS affects about 3 percent of people over 50 and progresses to myeloma at about 1 percent a year.
Low globulinBelow 2.0 g/dLImmune deficiency (IgG below about 400–500 mg/dL is clinically significant), protein loss, malnutrition, medications. Read with immunoglobulin levels.

High globulin

A high globulin almost always means your immune system is producing more antibodies than usual, or that a single abnormal antibody is being produced in large amounts. The distinction is made by protein electrophoresis. A polyclonal rise, a broad increase across the gamma region, is the body's response to a long-running stimulus: chronic viral hepatitis B or C, HIV, tuberculosis, endocarditis, parasitic infections, autoimmune diseases such as rheumatoid arthritis, lupus, Sjögren's syndrome and autoimmune hepatitis, sarcoidosis, and cirrhosis, where gut bacteria products bypass the liver and stimulate antibody production. Polyclonal increases are common, typically take globulin to 3.6 to 5 g/dL, and are a marker of the underlying disease rather than a disease in themselves.

A monoclonal rise, a sharp spike produced by one clone of plasma cells, is less common and more consequential. Most people with a monoclonal protein have MGUS (monoclonal gammopathy of undetermined significance), found in about 3 percent of people over 50 and 5 percent over 70, which causes no symptoms and needs only periodic monitoring because it progresses to myeloma at about 1 percent per year. Multiple myeloma is diagnosed when there is a monoclonal protein (often 3 g/dL or more) together with 10 percent or more plasma cells in the bone marrow and evidence of organ damage: high calcium, kidney impairment, anemia or bone lesions (the CRAB criteria). Waldenström macroglobulinemia produces an IgM spike and can thicken the blood; AL amyloidosis deposits light chains in organs.

Dehydration raises globulin along with albumin and total protein, so a mildly high globulin with a high-normal albumin and a normal A/G ratio is usually just concentration. Because globulin is calculated, a falsely low albumin from a lab method difference will also make globulin look high. A repeat sample, well hydrated, settles this before further tests are ordered.

Common causes

  1. Chronic infections

    Hepatitis B and C, HIV, tuberculosis, infective endocarditis, osteomyelitis, chronic abscesses, malaria, leishmaniasis and other long-running infections drive a polyclonal increase in IgG, often to 1,800–3,000 mg/dL.

  2. Autoimmune and inflammatory diseases

    Rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, autoimmune hepatitis, systemic sclerosis, sarcoidosis and inflammatory bowel disease raise gamma globulins polyclonally; alpha-1 and alpha-2 globulins also rise with active inflammation.

  3. Chronic liver disease and cirrhosis

    A damaged liver clears fewer bacterial antigens from the gut, so antibodies rise (especially IgA in alcohol-related disease and IgG in autoimmune hepatitis); globulin above albumin, with a low A/G ratio, is characteristic of cirrhosis.

  4. Multiple myeloma

    A malignant clone of plasma cells makes one antibody (IgG in about 55 percent, IgA in 20 percent) or light chains alone; globulin may be 4–8 g/dL, with anemia, bone pain, high calcium and kidney impairment. Incidence rises steeply after 60.

  5. Monoclonal gammopathy of undetermined significance (MGUS)

    A small monoclonal protein (under 3 g/dL) without organ damage, present in about 3 percent of adults over 50; most never progress, but it is monitored because about 1 percent a year become myeloma or a related disorder.

  6. Waldenström macroglobulinemia and lymphoma

    Waldenström produces large amounts of IgM, which can thicken the blood (hyperviscosity) causing blurred vision, headaches and nosebleeds; some lymphomas and chronic lymphocytic leukemia produce a monoclonal protein or polyclonal rise.

  7. Amyloidosis (AL type)

    Light chains from a plasma cell clone fold abnormally and deposit in the heart, kidneys, nerves and gut; the monoclonal protein is often small, so free light chains are the key test.

  8. Dehydration

    Concentrates all plasma proteins, raising globulin by 0.2–0.5 g/dL alongside albumin; the A/G ratio stays normal.

  9. Other causes

    Chronic allergic conditions and parasitic infections (raised IgE and IgG), IgG4-related disease, Castleman disease and some medications (phenytoin, hydralazine) occasionally raise globulin.

Symptoms that can go with it

  • Often none; a polyclonal rise is usually found on a routine panel and reflects the underlying condition
  • Fatigue, night sweats, low-grade fever or weight loss with chronic infection or lymphoma
  • Joint pain and stiffness, dry eyes and mouth, rashes or mouth ulcers with autoimmune disease
  • Bone pain (especially the back or ribs), fractures from minor injury, or unexplained anemia with myeloma
  • Frequent infections despite high antibody levels, because the abnormal antibody in myeloma does not work
  • Excessive thirst, constipation, confusion or kidney problems from high calcium in myeloma
  • Blurred vision, headaches, nosebleeds or bleeding gums from thickened blood (hyperviscosity) in Waldenström macroglobulinemia
  • Jaundice, swollen abdomen or spider veins on the skin with cirrhosis

Low globulin

A low globulin usually means you have fewer antibodies than normal, since the gamma globulins are the largest and most variable part of the fraction. The most common acquired reasons are medications that suppress antibody production: long-term corticosteroids, rituximab and other B-cell-depleting treatments, some anti-seizure drugs and chemotherapy. Protein loss through the kidneys in nephrotic syndrome or through the gut in protein-losing enteropathy lowers globulins alongside albumin, and severe malnutrition lowers everything. Chronic lymphocytic leukemia, myeloma (which suppresses normal antibodies while producing an abnormal one) and lymphoma all reduce normal immunoglobulins.

Primary (inherited) immune deficiencies are rarer but important. Common variable immunodeficiency (CVID), the most frequent in adults, is diagnosed when IgG is low (usually below about 450–500 mg/dL) together with low IgA or IgM, poor antibody responses to vaccines, and a history of repeated sinus, ear and chest infections; it is often picked up in the 20s to 40s after years of unexplained infections. Selective IgA deficiency, the most common inherited deficiency overall (about 1 in 500 people), does not usually lower total globulin enough to show on a metabolic panel. X-linked agammaglobulinemia presents in boys in infancy.

A low globulin that is only slightly below range (1.8–2.0 g/dL), with a normal albumin and no history of recurrent infections, is often just the arithmetic of a calculated value and is repeated. When it persists or infections are frequent, quantitative immunoglobulins (IgG, IgA, IgM) and sometimes IgG subclasses and vaccine antibody titres are measured. A high A/G ratio, usually above 2.5, nearly always points to low globulin rather than high albumin.

Common causes

  1. Corticosteroids and immune-suppressing medications

    Prednisone above about 10–20 mg a day for months, rituximab and other anti-CD20 drugs, mycophenolate, azathioprine, methotrexate and many chemotherapy regimens reduce antibody production; IgG can fall below 400 mg/dL after repeated rituximab courses.

  2. Common variable immunodeficiency (CVID) and other primary immunodeficiencies

    Inherited or acquired failure of B cells to make antibodies; IgG typically under 450–500 mg/dL with low IgA or IgM, recurrent bacterial sinus and lung infections, and poor responses to vaccines. Treated with immunoglobulin replacement.

  3. Nephrotic syndrome

    Leaky kidney filters lose IgG and other mid-sized proteins alongside albumin into the urine; larger proteins such as IgM and alpha-2 macroglobulin are retained, so the electrophoresis pattern is distinctive.

  4. Protein-losing enteropathy

    Celiac disease, Crohn's disease, intestinal lymphangiectasia and some infections leak all plasma proteins into the bowel, lowering albumin and globulins together.

  5. Chronic lymphocytic leukemia, myeloma and lymphoma

    Malignant clones crowd out or suppress normal plasma cells; in CLL, 25–50 percent of people develop low immunoglobulins over time, and in myeloma the normal antibodies are suppressed even as the abnormal one rises.

  6. Malnutrition and severe illness

    Prolonged inadequate protein and energy intake, advanced cancer and critical illness reduce synthesis of all plasma proteins.

  7. Alpha-1 antitrypsin deficiency

    Lowers the alpha-1 band specifically; total globulin may be only slightly low, but the flat alpha-1 region on electrophoresis is a clue in someone with early emphysema or unexplained liver disease.

  8. Acute hemolysis and acute liver failure

    Haptoglobin (alpha-2) falls sharply when red cells are destroyed; acute liver failure reduces production of alpha and beta globulins and complement.

Symptoms that can go with it

  • Often none when globulin is only slightly low
  • Repeated sinus infections, ear infections, bronchitis or pneumonia (typically two or more serious infections a year) with antibody deficiency
  • Infections that are unusually severe, slow to clear or need intravenous antibiotics
  • Chronic diarrhoea or poor weight gain, often from giardia or other gut infections in immune deficiency
  • Swelling, frothy urine or abdominal distension when protein loss through the kidneys or gut is the cause
  • Enlarged lymph nodes, spleen or unexplained fatigue in CLL or lymphoma
  • Breathlessness or wheeze at a young age in alpha-1 antitrypsin deficiency

Read it alongside

  • Albumin — the other half of the A/G ratio; a low ratio with normal globulin is an albumin problem (inflammation, liver, kidney or gut loss), not an antibody problem.
  • Total protein — a high total protein with a normal albumin confirms the globulin rise is real rather than a calculation artifact.
  • Serum protein electrophoresis (SPEP) with immunofixation — distinguishes a polyclonal rise (infection, inflammation, liver disease) from a monoclonal spike (MGUS, myeloma, Waldenström, amyloidosis).
  • Quantitative immunoglobulins (IgG, IgA, IgM) and serum free light chains — measure the individual antibody classes and detect light-chain-only clones that electrophoresis can miss.
  • CRP and ESR — a raised CRP supports an inflammatory or infectious cause; a very high ESR with a normal CRP is a classic clue to myeloma or Waldenström.
  • Hemoglobin, calcium and creatinine — the CRAB criteria; anemia, high calcium or kidney impairment alongside a monoclonal protein changes MGUS into myeloma.
  • ALT, AST, bilirubin and INR — a high globulin with a low albumin and abnormal liver tests fits chronic liver disease or autoimmune hepatitis.
  • Hepatitis B and C serology and HIV test — the commonest infectious causes of a persistent polyclonal rise.

What usually happens next

  1. A globulin just above range (3.6–4.0 g/dL) with a normal albumin is usually repeated in 4 to 8 weeks, well hydrated, with a CRP and liver tests; many settle or are explained by a recent infection.
  2. A globulin above 4.0 g/dL, an A/G ratio under 1.0 that is not explained by low albumin, or a persistently raised globulin leads to a serum protein electrophoresis, immunofixation, quantitative immunoglobulins and serum free light chains.
  3. A polyclonal pattern is followed by tests for the cause: hepatitis B and C, HIV, autoimmune screen (ANA, rheumatoid factor), liver imaging and, where relevant, a chest X-ray for sarcoidosis or tuberculosis.
  4. A monoclonal protein leads to a CBC, calcium, creatinine, a urine protein electrophoresis and, depending on the size of the spike and symptoms, a skeletal survey or whole-body MRI and a bone marrow biopsy; small spikes without organ damage are monitored every 6 to 12 months as MGUS.
  5. A low globulin with recurrent infections prompts quantitative immunoglobulins, IgG subclasses and vaccine response testing, and a review of medications that suppress antibodies.
  6. Ask whether your result was calculated or measured by electrophoresis, and whether your albumin was low, since that alone can produce a low A/G ratio.

Diet, lifestyle and natural levers with evidence

What can move Globulin and albumin/globulin ratio once the cause is known. Nothing here replaces finding the cause.

Limit alcohol

Moderate evidence

Heavy drinking raises globulin, particularly IgA, by increasing gut permeability so that bacterial products reach the liver and stimulate antibodies; IgA is 30 to 50 percent higher in heavy drinkers than in abstainers in population studies, and alcohol-related liver disease is the classic cause of a low A/G ratio with a polyclonal rise. Globulin and IgA fall toward normal over months of abstinence as the liver recovers and gut permeability improves.

Stay well hydrated before testing

Moderate evidence

Dehydration concentrates every plasma protein, and a mildly high globulin with a high-normal albumin is often nothing more than this. In studies of fluid restriction, total protein rises by 0.3 to 0.6 g/dL over 24 hours and returns to baseline within a day of rehydration. Drinking normally in the 24 hours before a repeat sample, and avoiding a prolonged tourniquet, removes this effect and avoids unnecessary electrophoresis.

Adequate protein and energy intake when globulin is low

Moderate evidence

Antibody production needs amino acids and energy; in protein-energy malnutrition, immunoglobulin levels and vaccine responses fall and recover with refeeding. Expert groups recommend 1.0–1.2 g of protein per kg daily for older adults and 1.2–1.5 g/kg during illness. In trials of nutritional supplementation in malnourished older adults, IgG and total protein rose by around 5 to 10 percent over 3 months. This lever applies to low globulin from poor intake; it does not raise antibody levels in people with primary immune deficiency or on immune-suppressing drugs.

Correct zinc and vitamin D deficiency if present

Preliminary evidence

Zinc is required for B-cell maturation and antibody production, and zinc deficiency, common in older adults, alcohol dependence and malabsorption, reduces immunoglobulin responses; supplementing deficient older adults with 15–45 mg a day for 6 to 12 months improved antibody responses to vaccines and reduced infection rates in several trials, with little effect in people who were replete. Vitamin D deficiency is associated with higher polyclonal globulin in autoimmune disease cohorts, but trials have not shown that supplementing changes globulin levels.

Zinc above 40 mg a day long term causes copper deficiency and anemia; test before supplementing rather than assuming deficiency.

Treat chronic inflammatory drivers: gum disease, weight and smoking

Preliminary evidence

Periodontal disease, obesity and smoking each maintain low-grade immune activation and are associated with higher IgG and globulin in population studies, with differences of around 0.1–0.3 g/dL between affected and unaffected groups. Treating periodontitis lowers CRP and IgG against oral bacteria in trials, and weight loss after bariatric surgery reduces immunoglobulin levels modestly. These are small effects; their main value is in reducing the inflammatory background rather than correcting a markedly high globulin, which needs a specific cause found.

When to see a clinician promptly

  • A globulin above 4.0 g/dL, a monoclonal protein on electrophoresis, or an A/G ratio under 1.0 not explained by low albumin, to arrange assessment for a plasma cell disorder.
  • High globulin with bone pain, fractures from minor injury, unexplained anemia, a calcium above 10.5 mg/dL or a rising creatinine: possible multiple myeloma, which needs prompt hematology review.
  • High globulin with blurred vision, severe headaches, nosebleeds, bleeding gums or confusion: possible hyperviscosity syndrome, an emergency.
  • High globulin with fever, night sweats, weight loss or enlarged lymph nodes, to be assessed for chronic infection or lymphoma.
  • Low globulin with two or more serious bacterial infections in a year, pneumonia more than once, or infections needing intravenous antibiotics, to be tested for antibody deficiency.
  • Low globulin with swelling, frothy urine or chronic diarrhoea, which suggests protein loss through the kidneys or gut.

Frequently asked questions

What is a normal globulin level?

About 2.0 to 3.5 g/dL (20 to 35 g/L) on most US labs; some use 2.3 to 3.5. It is calculated as total protein minus albumin, so a total protein of 7.0 with an albumin of 4.2 gives a globulin of 2.8. The albumin-to-globulin ratio is normally about 1.1 to 2.5. Ranges differ between labs, so compare with the one printed on your report.

What does a high globulin level mean?

Usually that your immune system is making more antibodies, in response to a chronic infection (hepatitis, HIV, tuberculosis), an autoimmune disease (rheumatoid arthritis, lupus, Sjögren's), or chronic liver disease, or that a single abnormal antibody is being overproduced by a plasma cell disorder such as MGUS or multiple myeloma. Dehydration raises it a little. A level above about 4 g/dL or a persistently high value is followed by a protein electrophoresis to tell these apart.

Is a globulin of 3.6, 3.8 or 4.0 high?

Slightly. Values of 3.6 to 4.0 g/dL are just above the usual range and are commonly a polyclonal response to a recent or chronic infection, an inflammatory condition, liver disease or mild dehydration; many return to range on repeat. A value of 4.0 or above, or one that stays raised, is the point at which most clinicians order a serum protein electrophoresis, immunoglobulin levels and free light chains to check for a monoclonal protein.

What does a low A/G ratio mean?

An A/G ratio below about 1.0 means globulin is close to or higher than albumin. That can happen because albumin is low (inflammation, liver disease, kidney or gut protein loss, malnutrition) or because globulin is high (chronic infection, autoimmune disease, cirrhosis, myeloma). Looking at the two numbers separately tells you which. A low ratio caused purely by low albumin is not an antibody problem and does not need electrophoresis on its own.

What does a high A/G ratio mean?

A ratio above about 2.5 usually means globulin is low: from steroids or immune-suppressing medications, an antibody deficiency, protein loss through the kidneys or gut, or occasionally leukemia. Less often, it reflects a high albumin from dehydration with a normal globulin. If you have frequent infections and a high ratio, quantitative immunoglobulins (IgG, IgA, IgM) are the next test.

Does high globulin mean cancer?

Usually not. Most high globulin results are polyclonal responses to infection, inflammation or liver disease. Among people who do have a monoclonal protein, the large majority have MGUS, a benign precursor that affects about 3 percent of people over 50 and progresses to myeloma at roughly 1 percent a year. Myeloma itself is diagnosed when a monoclonal protein is accompanied by bone marrow plasma cells of 10 percent or more and organ damage (high calcium, kidney impairment, anemia or bone lesions). Electrophoresis and free light chains sort out which situation applies.

What causes low globulin?

Medications that suppress antibody production (long-term corticosteroids, rituximab, chemotherapy, some anti-seizure drugs) are the commonest cause, followed by protein loss through the kidneys (nephrotic syndrome) or gut, malnutrition, and blood cancers such as chronic lymphocytic leukemia and myeloma. Inherited antibody deficiencies such as common variable immunodeficiency are rarer and present with repeated sinus, ear and chest infections. A slightly low value with no infections is often just the arithmetic of a calculated result.

What is the difference between globulin and gamma globulin?

Globulin on a metabolic panel is everything in the blood that is not albumin: alpha, beta and gamma globulins together. Gamma globulin is the specific band on protein electrophoresis that contains the antibodies (IgG, IgA and IgM), and it is the part that rises in infection, autoimmune disease and myeloma. Alpha and beta globulins are transport, clotting and complement proteins and change less. If your globulin is high, the electrophoresis shows which fraction is responsible.

References

  1. Total protein and albumin/globulin (A/G) ratio. MedlinePlus, US National Library of Medicine (2023)View source
  2. O'Connell TX, Horita TJ, Kasravi B. Understanding and interpreting serum protein electrophoresis. American Family Physician (2005)
  3. Vavricka SR, Burri E, Beglinger C, Degen L, Manz M. Serum protein electrophoresis: an underused but very useful test. Digestion (2009)
  4. Busher JT. Serum albumin and globulin. Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd edition (1990)
  5. Rajkumar SV, Dimopoulos MA, Palumbo A, et al.. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. The Lancet Oncology (2014)
  6. Kyle RA, Therneau TM, Rajkumar SV, et al.. Prevalence of monoclonal gammopathy of undetermined significance. New England Journal of Medicine (2006)
  7. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. American Journal of Hematology (2022)
  8. Bonilla FA, Khan DA, Ballas ZK, et al.. Practice parameter for the diagnosis and management of primary immunodeficiency. Journal of Allergy and Clinical Immunology (2015)
  9. Suh B, Park S, Shin DW, et al.. Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults. Annals of Oncology (2014)
  10. Monoclonal gammopathies. Merck Manual Professional Version (2024)
  11. Overview of immunodeficiency disorders. Merck Manual Professional Version (2024)

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