Albumin Transfusion Guidelines

Introduction to Albumin Transfusion

The International Collaboration for Transfusion Medicine Guidelines (ICTMG) and American College of Chest Physicians recommend against routine treatment of hypoalbuminemia alone, as there is weak evidence supporting its use for hypoalbuminemia alone and it does not improve clinical outcomes 1

Albumin transfusion may be considered in patients with liver disease complications, such as large-volume paracentesis (>5L), spontaneous bacterial peritonitis, and hepatorenal syndrome (with vasoconstrictors), as suggested by the American Gastroenterological Association and the American College of Chest Physicians 2, 1
Albumin may be used as a second-line fluid in septic shock when large volumes of crystalloids are required, with evidence supported by the Anaesthesia journal 3

Albumin administration is specifically not recommended in patients with chronic nephrosis, chronic cirrhosis without specific complications, malabsorption, protein-losing enteropathies, and undernutrition 1

Administering albumin carries risks including fluid overload and pulmonary edema, hypotension/tachycardia, allergic reactions, fever and rigors, and increased cost without clinical benefit, as advised by the American College of Chest Physicians and the American Gastroenterological Association 2, 1

The correct approach is to identify and treat the underlying cause of hypoalbuminemia, provide nutritional support to address protein deficiency if present, and control underlying inflammation, as recommended by the American College of Chest Physicians and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) 1
Albumin does not have a direct therapeutic role in treating acidosis, and current guidelines do not recommend its use for this purpose, as stated by the American College of Chest Physicians 1
Correction of acidosis reduces protein catabolism and may improve serum albumin levels in non-inflamed patients, as suggested by the American College of Chest Physicians 1

The typical dose of albumin infusion to support blood volume after fluid removal is 6-8g albumin per liter of ascitic fluid removed, according to the American Gastroenterological Association and the American College of Chest Physicians 2, 1
For certain conditions, the dosage is 1.5g/kg on day 1, followed by 1g/kg on day 3, as suggested by the American Gastroenterological Association and the American College of Chest Physicians 2, 1
Patients with jaundice and/or acute kidney injury at baseline are most likely to benefit from albumin administration, according to the American Gastroenterological Association 2

Multiple studies show no benefit in mortality or complication rates when albumin is given solely to correct low albumin levels, and evidence does not support routine use in most ICU patients, as stated by the American College of Chest Physicians and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) 1
The American College of Chest Physicians recommends against the routine treatment of hypoalbuminemia alone or as nutritional support with albumin, as well as against the routine use of albumin in most ICU patients and infections other than spontaneous bacterial peritonitis 2, 1