Albumin is an important intravascular and extravascular protein; it contributes strongly to the maintenance of colloid osmotic pressure.
Why is it important?
Binding and transport, osmotic pressure, free radical scavenging, platelet function inhibition and antithrombotic effects.
What causes serum albumin to decrease?
Decreased synthesis, increased catabolism, increased loss & redistribution.
* Consequences of decreased plasma albumin
1. Decreased ligand binding.
2. Decreased plasma colliod pressure
* Disease processes associated with Hypoalbuminaemia
In critical illness, there is a stronger correlation between colloid oncotic pressure and Total protein than with albumin.
Albumin decreases in burns, liver disease, renal disease, pre-eclampsia, stress and sepsis.
* Albumin as a prognostic index
Serum albumin concentration in critical illness is inversely related to the risk of death.
* Correcting Hypoalbuminaemia
The "normalisation" of plasma albumin concentrations has nor been shown to improve outcome in critical illness and in many of the traditional theraputic roles of albumin
* The recent fuss about albumin
The Cochrane report in the BMJ in July 1998 suggested that treatment with albumin was related to a 6% excess of deaths above control. Although this study was flawed in many ways, it has illustrated what many have believed for some time: that theraputic albumin therapy has little role in the management of most patients. Nevertheless, where albumin's use is well defined - in paediatrics / burns, it's abandonment does not appear justified at this time.
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