Concept to the Problems of Transfusion of Albumin
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 18, Issue 4
Abstract
The advantages of albumin over less costly alternative fluids continue to be debated. Many scientific articles were devoted to the clinical analysis of the use of albumin in acute illness as well as its comparison with other fluid regimens. However, the lack of fundamental knowledge about the physical and chemical properties of commercial albumin generates many unpromising discussions about the effectiveness of the use of albumin among practitioners and medical scientists. The manuscript provides information about the different variants of commercial albumin, the mechanisms of their action, indications and contraindications to use. The presented information is based on fundamental knowledge of physical and chemical properties of commercial albumin. This manuscript is not only educational information, but also is guide to action for clinicians.Human albumin (HA) or serum albumin is encoded by the ALB gene and is the most abundant plasma protein in mammals. Human albumin is essential for maintaining the osmotic pressure needed for proper distribution of body fluids between intravascular compartments and body tissues. Human albumin also acts as a plasma carrier by non-specifically binding several hydrophobic steroid hormones and as a transport protein for hemin and fatty acids. The advantages of albumin over less costly alternative fluids continue to be debated. Meta-analyses focusing on survival have been inconclusive, and other clinically relevant endpoints have not been systematically addressed. Database searches (MEDLINE, EMBASE, Cochrane Library) and other methods were used to identify randomized controlled trials comparing albumin with crystalloid, artificial colloid, no albumin or lower-dose albumin. Major findings for all endpoints were extracted and summarized [1,2]. Seventy-nine randomized trials with a total of 4755 patients were included. No significant treatment effects were detectable in 20/79 (25%) trials. In cardiac surgery, albumin administration resulted in lower fluid requirements, higher colloid oncotic pressure, reduced pulmonary edema with respiratory impairment and greater hemodilution compared with crystalloid and hydroxyethylstarch increased postoperative bleeding. In noncardiac surgery, fluid requirements, and pulmonary and intestinal edema were decreased by albumin compared with crystalloid. In hypoalbuminemia, higher doses of albumin reduced morbidity. In ascites, albumin reduced hemodynamic derangements, morbidity and length of stay and improved survival after spontaneous bacterial peritonitis. In sepsis, albumin decreased pulmonary edema and respiratory dysfunction compared with crystalloid, while hydroxyethylstarch induced abnormalities of hemostasis. Complications were lowered by albumin compared with crystalloid in burn patients. Albumin-containing therapeutic regimens improved outcomes after brain injury [3]. Neither benefit nor harm was shown when using HA to maintain hemodynamic stability in the perioperative period when compared with crystalloids or any other colloidal volume substitute [4-6]. In a recent study, the effects of crystalloids and colloids, including HA, on pulmonary edema in hypovolemic septic and non-septic patients with, or at risk of, acute lung injury/ acute respiratory distress syndrome were assessed.68 Pulmonary edema and lung injury score were not affected by the type of fluid indicating that HA was not superior to cheaper alternatives [7]. In a cohort, multicentre, observational study of 3147 ICU patients, the use of HA in European ICUs and its relationship to outcome were assessed [8]. The indication for giving albumin was not specified (hypovolemia or hypoalbuminemia). Three hundred and fifty-four patients (11.2%) received albumin and 2793 patients (88.8%) did not. Albumin administration was associated with decreased survival in this population of acutely ill patients.
Authors and Affiliations
Andrey Belousov
Keywords
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- EP ID EP621926
- DOI 10.26717/BJSTR.2019.18.003186
- Views 179
- Downloads 0
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