From the Guidelines
Albumin is contraindicated in patients with severe allergic reactions to albumin or its components, and should be avoided in patients with severe heart failure, pulmonary edema, or intracranial bleeding due to the risk of fluid overload and worsening of these conditions. According to the most recent guideline from the international collaboration for transfusion medicine guidelines 1, albumin should not be used as a first-line volume replacement or to increase serum albumin levels in critically ill adult patients, excluding those with thermal injuries and ARDS.
Key Considerations
- Patients with hypertension should receive albumin with caution, as it may increase blood pressure 1.
- Those with renal insufficiency may experience fluid retention with albumin administration, and patients with hepatic failure, particularly with esophageal varices, should use albumin cautiously as it may increase portal pressure 1.
- Albumin should be used with caution in patients with anemia, as it may cause hemodilution 1.
- The use of albumin in patients with spontaneous bacterial peritonitis (SBP) may be beneficial in preventing renal dysfunction and decreasing mortality, but its use in other infections is not recommended unless associated with acute kidney injury (AKI) 1.
Administration and Monitoring
When administering albumin, it is essential to monitor vital signs, fluid balance, and electrolyte levels to prevent complications related to fluid overload or electrolyte imbalances 1. The dose of albumin recommended in patients with SBP is 1.5 g/kg at day 1 and 1 g/kg at day 3, but lower doses may also be effective in reducing AKI 1.
Special Populations
In patients with cirrhosis and ascites, albumin should not be used as a standard treatment, unless there is a specific indication such as SBP or AKI 1. In patients with acute liver failure, albumin may be considered as part of the treatment regimen, but its use should be individualized based on the patient's clinical condition 1.
Overall, the use of albumin should be carefully considered in each patient, taking into account their underlying medical conditions, the potential benefits and risks of treatment, and the latest evidence-based guidelines 1.
From the Research
Contrindications for Albumin (Human Albumin)
- The use of albumin is not without adverse events, which mainly include allergic and transfusion reactions, volume overload, antibody formation, and coagulation derangements 2
- Hypersensitivity reactions to human serum albumin (HSA) are extremely rare, but can lead to severe and potentially fatal reactions if not recognized and treated promptly 3
- The cost of albumin infusions, lack of clear-cut benefits for survival, and fear of transmitting unknown viruses add to the controversy surrounding its use 4
- Albumin should not be used in hypoalbuminemia or for nutritional purposes 5
- The use of albumin for many indications is controversial, mostly because of the paucity of well-designed, randomized, controlled trials 4
Special Considerations
- In patients with acute-on-chronic liver failure, potentially toxic oxidized isoforms of albumin increase substantially, and the role of administration of human albumin solutions (HAS) in such patients is unclear 2
- Determining whether removal of the pathological and dysfunctional albumin forms in these patients by "albumin dialysis" is helpful, requires additional studies 2
- Judicious use of HAS in liver diseases is advocated, considering their cost, limited availability, need for a health care setting for their administration, and potential adverse effects 2