What is the indication for Albumin (Human Albumin) infusion?

From the Guidelines

Indication for Albumin Infusion

Albumin infusion is indicated for patients with hypoalbuminemia, significant blood volume loss, and complications of cirrhosis such as spontaneous bacterial peritonitis (SBP) and large-volume paracentesis 1.

• The treatment aims to maintain intravascular volume, correct low serum albumin levels, and mobilize extravascular fluid.
• The recommended dose varies depending on the clinical scenario, but a common dose is 1-2 grams per kilogram of body weight, administered over 30 minutes to 2 hours, with a maximum daily dose of 4-6 grams per kilogram 1.
• For patients with SBP, a dose of 1.5 g albumin/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3, is recommended to prevent renal dysfunction and decrease mortality 1.
• In patients undergoing large-volume paracentesis, albumin should be infused at a dose of 8 g albumin/L of ascites removed to prevent post-paracentesis circulatory dysfunction 1.
• It is essential to weigh the potential benefits and risks of albumin infusion, considering its high cost and potential adverse consequences such as fluid overload, hypotension, and anaphylaxis 1.

From the FDA Drug Label

Emergency Treatment of Hypovolemic Shock Plasbumin-25 is hyperoncotic and on intravenous infusion will expand the plasma volume by an additional amount, three to four times the volume actually administered, by withdrawing fluid from the interstitial spaces, provided the patient is normally hydrated interstitially or there is interstitial edema. Removal of ascitic fluid from a patient with cirrhosis may cause changes in cardiovascular function and even result in hypovolemic shock. In such circumstances, the use of an albumin infusion may be required to support the blood volume. Burn Therapy An optimal therapeutic regimen with respect to the administration of colloids, crystalloids, and water following extensive burns has not been established. During the first 24 hours after sustaining thermal injury, large volumes of crystalloids are infused to restore the depleted extracellular fluid volume Beyond 24 hours Plasbumin-25 can be used to maintain plasma colloid osmotic pressure. Hypoproteinemia With or Without Edema During major surgery, patients can lose over half of their circulating albumin with the attendant complications of oncotic deficit. Adult Respiratory Distress Syndrome (ARDS) This is characterized by deficient oxygenation caused by pulmonary interstitial edema complicating shock and postsurgical conditions. When clinical signs are those of hypoproteinemia with a fluid volume overload, Plasbumin-25 together with a diuretic may play a role in therapy Cardiopulmonary Bypass With the relatively small priming volume required with modern pumps, preoperative dilution of the blood using albumin and crystalloid has been shown to be safe and well-tolerated Acute Liver Failure In the uncommon situation of rapid loss of liver function with or without coma, administration of albumin may serve the double purpose of supporting the colloid osmotic pressure of the plasma as well as binding excess plasma bilirubin Neonatal Hemolytic Disease The administration of Plasbumin-25 may be indicated prior to exchange transfusion, in order to bind free bilirubin, thus lessening the risk of kernicterus. Sequestration of Protein Rich Fluids This occurs in such conditions as acute peritonitis, pancreatitis, mediastinitis, and extensive cellulitis. The magnitude of loss into the third space may require treatment of reduced volume or oncotic activity with an infusion of albumin

The indications for Albumin (Human Albumin) infusion are:

• Hypovolemic Shock: to expand plasma volume
• Burn Therapy: to maintain plasma colloid osmotic pressure
• Hypoproteinemia: to treat oncotic deficit
• Adult Respiratory Distress Syndrome (ARDS): to treat hypoproteinemia with fluid volume overload
• Cardiopulmonary Bypass: for preoperative dilution of blood
• Acute Liver Failure: to support colloid osmotic pressure and bind excess bilirubin
• Neonatal Hemolytic Disease: to bind free bilirubin prior to exchange transfusion
• Sequestration of Protein Rich Fluids: to treat reduced volume or oncotic activity in conditions such as acute peritonitis, pancreatitis, and extensive cellulitis 2 2

From the Research

Indications for Albumin Infusion

The indications for albumin infusion can be summarized as follows:

• Hypovolemia: Albumin infusion is used to expand plasma volume in patients with hypovolemia, particularly after major surgery or in critically ill patients 3, 4, 5, 6.
• Hypoalbuminemia: Albumin infusion is used to increase colloid osmotic pressure in patients with hypoalbuminemia, which can help to prevent or treat complications such as edema and ascites 4, 7.
• Prevention of intradialytic hypotension: Albumin infusion has been shown to be effective in preventing intradialytic hypotension in hospitalized hypoalbuminemic patients undergoing hemodialysis 7.

Patient Populations

Albumin infusion may be indicated in the following patient populations:

• Post-operative patients with signs of hypovolemia or hypoperfusion 5, 6
• Critically ill patients with hypoalbuminemia or hypovolemia 4
• Patients with acute blood loss or severe sepsis 3
• Hospitalized patients with hypoalbuminemia undergoing hemodialysis 7

Key Findings

Key findings from the studies include:

• Albumin infusion can effectively expand plasma volume and increase colloid osmotic pressure 3, 4, 5, 6
• The optimal infusion rate for albumin is unclear, with some studies suggesting that a slow infusion rate may be less effective than a rapid infusion rate 6
• Albumin infusion may be beneficial in preventing intradialytic hypotension and improving fluid removal in hospitalized hypoalbuminemic patients undergoing hemodialysis 7