Is fever a contraindication to Human Albumin (Albumin) infusion?

From the Guidelines

Fever is not a contraindication to albumin infusion. Patients with fever can safely receive albumin when clinically indicated for conditions such as hypovolemia, hypoalbuminemia, or other approved indications. However, healthcare providers should monitor patients closely during the infusion, as fever could potentially be a sign of an underlying infection or, rarely, a reaction to the albumin itself. The standard administration of albumin (typically 5% or 25% solutions) can proceed at the prescribed rate even in febrile patients. If a patient develops fever during albumin administration that wasn't present before, clinicians should evaluate for possible infusion reactions, though these are uncommon with albumin compared to other blood products. Albumin is generally well-tolerated because it's a naturally occurring human protein that undergoes purification processes to minimize immunogenicity. The presence of fever alone should not delay albumin therapy when it's otherwise indicated for a patient's clinical condition, as supported by recent guidelines such as the one published in Chest in 2024 1.

Key considerations for albumin infusion in patients with fever include:

• Monitoring for signs of infection or infusion reaction
• Evaluating the clinical indication for albumin therapy
• Proceeding with standard administration protocols unless contraindicated by other factors
• Recognizing that fever itself is not a contraindication to albumin infusion, based on the most recent and highest quality evidence available 1.

It's also important to note that other guidelines, such as those from the American Association for the Study of Liver Diseases published in Hepatology in 2021 1, may discuss albumin use in specific contexts like cirrhosis and ascites, but these do not address the general question of fever as a contraindication to albumin infusion directly. Therefore, the primary consideration should be the patient's overall clinical condition and the specific indications for albumin therapy, rather than the presence of fever alone.

From the Research

Albumin Infusion and Fever

• There is no direct evidence to suggest that fever is a contraindication to albumin infusion 2, 3, 4.
• The use of albumin is generally guided by evidence-based indications, such as fluid resuscitation in shock states, liver disease, and certain other conditions 2.
• Fever is not mentioned as a contraindication to albumin infusion in the available studies 2, 3, 4, 5, 6.
• However, it is worth noting that the management of hypoalbuminemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin 6.

Evidence-Based Indications for Albumin Infusion

• Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin 2.
• Albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use 2.

Antipyretic Drugs and Fever

• The use of antipyretic drugs to suppress fever during infection remains a controversial topic within the literature 5.
• The evidence does not currently support routine antipyretic administration, and considering patients' comorbidities and symptoms of their underlying illness will promote safe, evidence-based and appropriate administration of antipyretics 5.