Albumin Administration Guidelines

Evidence-Based Recommendations

The International Collaboration for Transfusion Medicine Guidelines recommend against albumin use in common clinical scenarios, with 12 of 14 recommendations advising against its use, according to the American Thoracic Society 1, 2, 3
Albumin is not recommended for first-line volume replacement in critically ill adults, excluding thermal injuries and ARDS, with moderate certainty of evidence, as stated by the American Thoracic Society 3
Low serum albumin is a marker of illness severity, not a treatment target, according to the American Thoracic Society 3
The American College of Chest Physicians recommends against the routine use of albumin due to its high cost and lack of proven superiority in most settings 3, 4
Albumin administration is indicated for large-volume paracentesis (>5L) in cirrhotic patients to prevent paracentesis-induced circulatory dysfunction, with conditional recommendations and very low certainty of evidence, as recommended by the American Association for the Study of Liver Diseases 3
The American College of Gastroenterology recommends albumin administration for spontaneous bacterial peritonitis in cirrhotic patients, with conditional recommendations and very low certainty of evidence 3
The use of albumin in cirrhosis-related indications has conditional recommendations with very low certainty of evidence, but represents the most accepted uses of albumin in current practice, according to the American Association for the Study of Liver Diseases 1, 2, 3, 5

Fluid overload and pulmonary edema may occur, especially if infused >2 mL/min in hypoproteinemic patients, as warned by the American Thoracic Society 3
Hemodilution requiring additional RBC transfusion is a potential risk, according to the American Thoracic Society 3
Hypotension, anaphylaxis, and peripheral gangrene from dilution of natural anticoagulants are potential adverse effects, as reported by the American Thoracic Society 3