Is it reasonable to give albumin (human albumin) transfusion when serum albumin level is severely low (hypoalbuminemia)?

Albumin Transfusion for Severe Hypoalbuminemia

Albumin transfusion is not recommended solely to correct a low serum albumin level of 18 g/L, as there is weak evidence supporting its use for hypoalbuminemia alone and it does not improve clinical outcomes. 1, 2

Evidence Against Routine Albumin Administration for Hypoalbuminemia

The International Collaboration for Transfusion Medicine Guidelines (ICTMG) and American College of Chest Physicians explicitly recommend against routine treatment of hypoalbuminemia alone 1, 2. Current guidelines indicate:

• Low serum albumin is a marker of inflammation and underlying disease, not a condition requiring direct treatment 3, 4
• Hypoalbuminemia is caused by a combination of inflammation, reduced synthesis, and increased degradation 3, 5
• Simply administering albumin to patients with hypoalbuminemia has not been shown to improve survival or reduce morbidity 3, 6

Appropriate Management Approach

Instead of albumin transfusion, the correct approach is:

1. Identify and treat the underlying cause of hypoalbuminemia (inflammation, malnutrition, liver disease, etc.) 2
2. Provide nutritional support to address protein deficiency if present 2, 4
3. Control underlying inflammation which is often the primary driver of low albumin levels 3, 4

Limited Specific Indications for Albumin

Albumin transfusion may be considered in specific clinical scenarios:

• Liver disease complications:

  • Large-volume paracentesis (>5L) 1, 2, 7
  • Spontaneous bacterial peritonitis 1, 2, 7
  • Hepatorenal syndrome (with vasoconstrictors) 2, 8

• Other potential indications:

  • Hypovolemic shock (as second-line therapy after crystalloids) 7
  • Burn therapy (beyond 24 hours after injury) 7
  • Sequestration of protein-rich fluids (peritonitis, pancreatitis) 7
  • Acute liver failure 7

Situations Where Albumin is Not Warranted

Albumin administration is specifically not recommended in:

• Chronic nephrosis 7
• Chronic cirrhosis without specific complications 7
• Malabsorption 7
• Protein-losing enteropathies 7
• Undernutrition 7

Potential Risks of Albumin Administration

Administering albumin carries risks including:

• Fluid overload and pulmonary edema 2, 7
• Hypotension/tachycardia 2
• Allergic reactions (rash, pruritus) 2
• Fever and rigors 2
• Increased cost without clinical benefit 6

Conclusion

The British Society of Gastroenterology notes that "evidence to support the use of intravenous albumin is weak" and that correction of hypoalbuminemia depends on treating underlying sepsis and controlling inflammation 1. Focus treatment on the underlying cause of hypoalbuminemia rather than simply correcting the low albumin level, as this approach addresses the root problem and is more likely to improve clinical outcomes.