From the Guidelines
Albumin is contraindicated in patients with a history of allergic reactions to albumin or its components, and its use should be avoided in patients with severe heart failure, pulmonary edema, or those at risk for hypervolemia, as it can worsen their condition. The use of albumin in critically ill adult patients, excluding those with thermal injuries and ARDS, is not suggested for first-line volume replacement or to increase serum albumin levels, as stated in the guideline from the international collaboration for transfusion medicine guidelines 1.
Key Considerations
- Patients with severe heart failure or pulmonary edema should avoid albumin due to the risk of increased plasma volume worsening their condition.
- Caution is necessary in patients with hypertension, as albumin infusion may increase blood pressure.
- Albumin is not recommended for patients with severe anemia, as it does not improve oxygen-carrying capacity.
- Patients with renal or hepatic failure require careful administration due to potential fluid overload.
- The medication carries a theoretical risk of disease transmission, although modern processing techniques have minimized this concern.
Specific Scenarios
- In critically ill adult patients with thermal injuries or ARDS, intravenous albumin is not suggested for volume replacement or to increase serum albumin level, as per the guideline from the international collaboration for transfusion medicine guidelines 1.
- The use of albumin in cardiac surgery, particularly for priming the cardiopulmonary bypass circuit, is not recommended due to the lack of benefit in reducing mortality, renal injury, or coagulopathy, and the potential for increased bleeding and infection, as found in the ALBICS trial 1.
- In patients with cirrhosis, the use of albumin should be judicious, especially when used in conjunction with vasoactive drugs like terlipressin, due to the risk of respiratory failure and other complications, as noted in the AGA clinical practice update 1.
Monitoring and Administration
- Albumin administration requires monitoring for signs of allergic reactions, fluid overload, or electrolyte imbalances.
- Patients should be closely monitored for vital signs, including pulse oximetry, especially when receiving terlipressin for hepatorenal syndrome, to minimize the risk of respiratory failure.
From the FDA Drug Label
CONTRAINDICATIONS Certain patients, e.g., those with a history of congestive cardiac failure, renal insufficiency or stabilized chronic anemia, are at special risk of developing circulatory overload. A history of an allergic reaction to albumin is a specific contraindication to usage. The contraindications for albumin (human albumin) are:
- A history of allergic reaction to albumin
- Patients at special risk of developing circulatory overload, including those with:
- History of congestive cardiac failure
- Renal insufficiency
- Stabilized chronic anemia 2
From the Research
Contrindications for Albumin (Human Albumin)
The use of human albumin solutions (HAS) is not without adverse events. These mainly include:
- Allergic and transfusion reactions
- Volume overload
- Antibody formation
- Coagulation derangements 3 In patients with acute-on-chronic liver failure, potentially toxic oxidized isoforms of albumin increase substantially, which may be a contrindications for the use of HAS in such patients 3.
Cardiovascular Diseases
Low serum albumin levels have been associated with an increased risk of cardiovascular diseases, including coronary artery disease, heart failure, atrial fibrillation, and stroke 4. Hypoalbuminemia has also been shown to be a powerful prognostic marker in patients with cardiovascular diseases 4, 5, 6, 7.
Heart Failure
In patients with heart failure, low serum albumin levels have been associated with increased mortality, longer hospital stays, and increased cardiac-related hospitalizations 5, 6, 7. Hypoalbuminemia has been shown to be a significant predictor of reduced survival in patients with chronic heart failure 7.
Precautions
The use of HAS should be rationalized, considering the dose, duration, and frequency of albumin therapy in different liver diseases and stages of cirrhosis 3. Additionally, the cost, limited availability, and potential adverse effects of HAS should be taken into account when deciding to use them in patients with liver diseases 3.