Albumin Does Not Transmit Viral Hepatitis
Among the listed blood products (cryoprecipitate, immunoglobulin, packed RBCs, and albumin), albumin is the only one that does not transmit viral hepatitis.
Evidence for Safety of Albumin
Albumin has maintained an impressive 50-year safety record with no documented transmission of hepatitis viruses 1. This exceptional safety profile is due to the manufacturing process that includes heating at 60°C for 10 hours, which effectively inactivates viral particles 2.
Risk Assessment of Blood Products
High-Risk Products:
Packed RBCs: These cellular components can transmit hepatitis viruses through infected donor blood. Recipients of whole blood and blood cellular components have historically been at increased risk for HCV infection 3.
Cryoprecipitate: As a plasma-derived product that undergoes less extensive viral inactivation processing than albumin, cryoprecipitate carries a risk of viral hepatitis transmission 2, 4.
Variable-Risk Products:
- Immunoglobulin (Ig): While generally considered safer than cellular components, immunoglobulin products have been associated with hepatitis transmission in specific circumstances. Intravenous immunoglobulin (IVIG) that was not virally inactivated was the source of a hepatitis C outbreak during 1993-1994 3. Since December 1994, all IG products (both IV and IM) commercially available in the United States must undergo viral inactivation procedures or test negative for HCV RNA before release 3.
No-Risk Products:
- Albumin: The manufacturing process for albumin includes heating at 60°C for 10 hours, which effectively inactivates hepatitis viruses 2. This heat treatment process has made albumin extremely safe with no documented transmission of hepatitis B or C viruses in its 50-year history 1.
Viral Inactivation Processes
The risk of viral hepatitis transmission through blood products has been significantly reduced through:
- Donor screening: Testing for HBsAg, anti-HCV, and other markers
- Manufacturing processes: Heat treatment, solvent/detergent treatment, nanofiltration
- Quality control: Testing final products for viral markers
Albumin's manufacturing process specifically includes heat treatment at 60°C for 10 hours, which is particularly effective at inactivating both hepatitis B and C viruses 2.
Clinical Implications
When administering blood products to patients, it's important to consider the risk-benefit ratio:
- For patients requiring volume expansion without specific clotting factors or cellular components, albumin represents the safest choice regarding viral hepatitis risk
- For patients requiring other blood products, the benefits often outweigh the small remaining risk of viral transmission with modern screening and manufacturing processes
Common Pitfalls
Assuming all plasma derivatives carry equal risk: The manufacturing processes vary significantly between products, with albumin undergoing the most rigorous viral inactivation procedures
Overlooking newer safety measures: Since the 1990s, significant improvements in donor screening and viral inactivation have dramatically reduced transmission risks for all blood products
Confusing historical with current risks: While historical data showed significant risks with many blood products, modern screening and manufacturing have substantially improved safety profiles
In summary, albumin stands out as the blood product with the longest documented safety record regarding viral hepatitis transmission due to its effective heat treatment manufacturing process.