Plasma proteins are synthesized predominantly in the liver, plasma cells, lymph nodes, the spleen and in bone marrow. In the course of disease the total protein concentration and also the percentage represented by individual fractions can significantly deviate from normal values. Hypoproteinemia can be caused by diseases and disorders such as loss of blood, sprue, nephrotic syndrome, severe burns, salt retention syndrome and Kwashiorkor (acute protein deficiency). Hyperproteinemia can be observed in cases of severe dehydration and illnesses such as multiple myeloma. Changes in the relative percentage of plasma proteins can be due to a change in the percentage of one plasma protein fraction. Often in such cases the amount of total protein does not change. The A/G - ratio is commonly used as an index of the distribution of albumin and globulin fractions. Marked changes in this ratio can be observed in cirrhosis of the liver, glomerulonephritis, nephrotic syndrome, acute hepatitis, lupus erythematosus as well as in certain acute and chronic inflammations. Total protein measurements are used in the diagnosis and treatment of a variety of diseases involving the liver, kidney or bone marrow, as well as other metabolic or nutritional disorders.