Do albumin (human albumin) transfusions exist?

Albumin Transfusions: Clinical Applications and Evidence

Yes, albumin transfusions exist and are widely used in clinical practice as a human-derived blood product manufactured from donated human plasma. 1

What is Albumin?

• Albumin is administered intravenously as a human-derived blood product available in different concentrations (typically 5%, 20%, or 25%) 1
• It accounts for approximately 70% of plasma colloid osmotic pressure and has multiple physiological functions beyond fluid compartmentalization 2
• Functions include binding and transport of substances, antioxidant properties, immune modulation, anti-inflammatory activity, and endothelial stabilization 2, 3

Evidence-Based Indications for Albumin Use

Strong Evidence for Use:

• Patients with cirrhosis undergoing large-volume paracentesis (conditional recommendation, moderate certainty of evidence) 1, 4
• Patients with spontaneous bacterial peritonitis (conditional recommendation, moderate certainty of evidence) 1, 4
• Fluid replacement in plasmapheresis (moderate to high quality evidence) 4
• Hepatorenal syndrome (in combination with vasoconstrictors) 4, 3

Limited or Weak Evidence for Use:

• Second-line fluid resuscitation in hypovolemic shock when crystalloids are ineffective 5, 4
• Sepsis and septic shock (as adjunctive therapy) 4
• Severe burns and toxic epidermal necrolysis 4
• Intradialytic hypotension 5, 4
• Major surgery in specific circumstances 5, 4
• Severe and refractory edema with hypoalbuminemia not responding to other treatments 4

Not Recommended for Routine Use:

• Critically ill adult patients (excluding thermal injuries and ARDS) for first-line volume replacement or to increase serum albumin levels 1
• Treatment of hypoalbuminemia alone without addressing underlying cause 5, 6
• Nutritional supplementation 4, 2
• Neonatal and pediatric critical care for routine use 1, 6
• Cardiovascular surgery for routine use 1
• Kidney replacement therapy for routine use 1
• Patients with cirrhosis for treatment of hypoalbuminemia or extraperitoneal infections 1

Clinical Considerations and Pitfalls

Important Considerations:

• Albumin is more expensive than crystalloids (approximately $130/25g in US dollars) 1
• Practice audits show highly variable usage patterns among different regions 1
• In liver disease, albumin function is several times less than its concentration (concept of "effective albumin concentration") 3

Potential Adverse Effects:

• Fluid overload 1
• Hypotension 1
• Hemodilution requiring RBC transfusion 1
• Anaphylaxis 1
• Peripheral gangrene from dilution of natural anticoagulants 1

Current Research

• Multiple ongoing large randomized clinical trials are investigating albumin use in:
  • Hypoalbuminemic patients with community-acquired pneumonia 1
  • Septic shock 1
  • High-risk cardiac surgery 1
  • Long-term administration for decompensated cirrhosis with ascites 1
  • Acute kidney injury requiring kidney replacement therapy 1

Clinical Decision Algorithm

1. Identify if patient has one of the evidence-based indications (cirrhosis with large-volume paracentesis, spontaneous bacterial peritonitis, hepatorenal syndrome)
2. For other conditions, consider albumin only after crystalloids have failed or are contraindicated
3. Never use albumin solely to correct hypoalbuminemia without addressing the underlying cause
4. Consider cost-effectiveness and availability of albumin in your clinical setting
5. Monitor for potential adverse effects during administration

Human albumin transfusions should be prescribed based on evidence-based guidelines rather than tradition or habit, as many common uses lack supporting evidence for improved patient outcomes 1.