Albumin and Plasma Protein Preparations

Several commercial products containing albumin are available for use to increase intravascular volume. Albumin is available as a 5% or a 25% solution in isotonic saline. Plasma protein fractions containing albumin and α- and β-globulins are available. These solutions are prepared commercially from albumin fractions from large pools of plasma reconstituted in isotonic electrolyte solutions. Such solutions can be given without regard to ABO blood type and without crossmatch and should be used primarily as volume expanders. They are very expensive and in short supply. Bacterial sepsis has been associated with albumin administration. ^[145] For much of 1997, there was a shortage of 5% albumin because of the concern about contamination with vCJD. If available, albumin should be administered within 4 hours of initiation of the infusion because of potential contamination after entering the bottle. In 2003, Vincent and associates^[146] analyzed all adverse reports on the 10 major suppliers of human albumin worldwide from 1998 to 2000. Although cases were possibly under-reported, the investigators concluded that adverse events were rare with human albumin administration. It appears to be quite safe, but the indications for its use are controversial.

I believe that administration of the plasma protein fraction of 5% serum albumin solutions should be restricted for the treatment of documented hypoproteinemia or conditions such as burns and peritonitis, in which hypoproteinemia is likely. These solutions expand the vascular space for a longer period than balanced electrolyte solutions. However, albumin's osmotic ability draws fluid into the vascular space from other extracellular fluid compartments. In most states of hypovolemia and dehydration, the entire extracellular fluid space already is depleted. Fluids such as 0.9% saline or lactated Ringer's solution, which expand the entire extracellular fluid space, should be given.