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Albumin

Also known as: Albumin, Human Serum Albumin, Human Albumin

Overview

Human Albumin is a vital protein naturally produced by the liver, constituting a significant component of human blood plasma. Its primary physiological roles include maintaining oncotic pressure, which is crucial for regulating blood volume and preventing fluid leakage from blood vessels into tissues. Beyond fluid balance, albumin acts as a versatile transporter, binding and carrying a wide array of substances throughout the body, including hormones, vitamins, fatty acids, drugs, and calcium. In medical settings, Human Albumin is extensively used for therapeutic purposes, particularly in conditions involving hypovolemia (low blood volume), shock, and hypoalbuminemia (low albumin levels). Its high molecular weight and strong binding capabilities make it an effective colloid fluid for plasma volume expansion and drug delivery. Research on Human Albumin is extensive, especially in critical care, with numerous systematic reviews and meta-analyses evaluating its efficacy and safety in various clinical scenarios, including sepsis and liver disease.

Benefits

Human Albumin offers several evidence-based benefits, primarily in specific clinical contexts. A meta-analysis indicated that hyperoncotic albumin may reduce 28-day mortality in patients with septic shock (OR 0.82, 95% CI: 0.68–0.98), suggesting a moderate but clinically significant effect in this subgroup. However, for general sepsis patients, most studies, including randomized controlled trials and systematic reviews, have not shown a significant reduction in mortality when compared to crystalloid solutions. A key secondary benefit is its role in fluid balance; hyperoncotic albumin has been shown to reduce cumulative fluid balance in early sepsis, which can be beneficial in managing fluid overload. The benefits are most pronounced in specific populations, such as those with septic shock, where the evidence, though limited by some study biases, points towards improved outcomes. The time course of these benefits is typically observed within the first 28 days of treatment.

How it works

Human Albumin primarily functions by maintaining oncotic pressure within the bloodstream, which is essential for regulating fluid distribution between the intravascular and extravascular spaces. By increasing the colloid osmotic pressure, albumin draws fluid from the interstitial space back into the capillaries, thereby expanding plasma volume and improving blood circulation. It also acts as a crucial transport protein, binding to and carrying various endogenous and exogenous substances, including hormones, fatty acids, bilirubin, and many drugs. This binding capacity influences the pharmacokinetics and bioavailability of these substances. When administered intravenously, albumin is immediately available in the bloodstream, exerting its effects on blood volume and substance transport, thus supporting circulatory function and organ perfusion.

Side effects

Human Albumin is generally considered safe when administered appropriately in medical settings. However, like all medical interventions, it carries potential side effects. Common side effects are rare but may include mild allergic reactions such as rash or itching. Uncommon side effects can involve more pronounced hypersensitivity reactions, while rare but severe reactions like anaphylaxis, a life-threatening allergic response, have been reported. Patients should be monitored for signs of allergic reactions during and after administration. Human Albumin can also interact with certain drugs, potentially altering their pharmacokinetics due to its strong binding capabilities. Contraindications include known hypersensitivity to albumin or any of its components. Caution is advised when administering albumin to specific populations, such as patients with severe liver disease or heart failure, as rapid volume expansion could exacerbate conditions like pulmonary edema or circulatory overload. Careful clinical assessment and monitoring are crucial to ensure patient safety.

Dosage

The dosage of Human Albumin varies significantly based on the patient's clinical condition, the specific indication, and the desired therapeutic effect. Typically, 20% albumin solutions are used for fluid resuscitation and to increase oncotic pressure. The optimal dosage range is not fixed but is often titrated by medical professionals to achieve and maintain target serum albumin levels or to restore adequate circulating blood volume. For instance, in conditions like septic shock, the dosage might be adjusted based on fluid balance and hemodynamic parameters. There isn't a universally defined maximum safe dose, as it depends heavily on the patient's underlying health status and the clinical context; however, excessive administration can lead to fluid overload. Albumin is exclusively administered intravenously, ensuring immediate bioavailability and rapid onset of action. Timing of administration is critical and is typically guided by ongoing clinical assessment and patient needs, such as in acute hypovolemia or shock. No specific cofactors are required for its efficacy.

FAQs

Is Albumin a nutritional supplement for general use?

No, Human Albumin is not a general nutritional supplement. It is a prescription medication primarily used in hospital settings for specific medical conditions like shock, fluid resuscitation, and severe protein deficiency, under strict medical supervision.

How is Human Albumin administered?

Human Albumin is administered intravenously (directly into a vein) by healthcare professionals. This method ensures immediate availability in the bloodstream to exert its therapeutic effects.

What are the main expected results of Albumin administration?

Expected results include improved blood volume, maintenance of oncotic pressure, and transport of various substances. In specific cases like septic shock, it may contribute to reduced mortality, though its benefits are not consistent across all sepsis patients.

Are there any common safety concerns with Albumin?

While generally safe, potential side effects include allergic reactions, ranging from mild rashes to rare severe anaphylaxis. Patients are monitored for these reactions during and after administration.

Can Albumin interact with other medications?

Yes, Albumin can affect the pharmacokinetics of certain drugs due to its strong binding capabilities. Healthcare providers consider potential drug interactions when prescribing Albumin.

Research Sources

https://www.bmj.com/content/349/bmj.g4561 – This randomized controlled trial (Annane et al., 2013) investigated fluid therapy in ICU patients, including albumin. It concluded that there was no significant difference in mortality when comparing mixed colloid solutions, including albumin, to crystalloid solutions for fluid resuscitation.
https://journals.sagepub.com/doi/10.1177/17511437241259437 – This randomized controlled trial (Caironi et al., 2014) compared 20% albumin with crystalloid fluids in adults with severe sepsis. It found no significant difference in 28-day mortality but suggested that albumin might help reduce the duration of shock, indicating a nuanced benefit.
https://onlinelibrary.wiley.com/doi/10.1155/2022/2384730 – This systematic review and meta-analysis (Liu et al., 2022) synthesized evidence on albumin supplementation in sepsis patients. It concluded that there was no significant difference in in-hospital mortality at 7 and 28 days between albumin supplements and crystalloid solutions, reinforcing the limited overall mortality benefit in general sepsis.