If hepatic synthesis decreases, what happens to albumin and globulin levels?

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Albumin is made almost entirely by liver cells, so when hepatic synthesis falls, serum albumin levels drop. This loss of albumin lowers the plasma oncotic pressure and is a hallmark of liver dysfunction.

Globulins are a mixed bag. The alpha and beta portions are largely produced by the liver, but the gamma globulins (immunoglobulins) come from plasma cells in lymphoid tissue such as bone marrow and the spleen. Because some globulins are produced outside the liver, a decrease in liver synthesis doesn’t automatically cause globulin levels to fall; they may stay the same or even rise (for example, a polyclonal increase in immunoglobulins is common in chronic liver disease).

So, when hepatic synthesis decreases, albumin tends to decrease, whereas globulin levels do not necessarily decrease and may actually be unchanged or increased due to immune activity. The idea that globulins are produced in the spleen and would drop with liver failure isn’t correct, since their production isn’t exclusively hepatic.