Not all it is cracked up to be

Albumin solutions are commonly used to treat low serum albumin concentrations and hypovolaemia. Human albumin effectively replaces volume and supports colloid oncotic pressure. Unlike synthetic colloids, it has transport functions and binds reversibly with anions, cations, and some substances that are active or toxic only in the free form. It is a scavenger of free radicals1 and improves prognosis in the sheep model of the adult respiratory distress syndrome.2 It has anticoagulant properties, inhibiting platelet aggregation and enhancing the inhibition of factor Xa by antithrombin III.3 4 It may also have a role in preserving microvascular integrity, which is possibly mediated by glycoproteins distributed through the capillary membrane.5

Common reasons for using albumin rather than synthetic alternatives are generally clinical associations and beliefs related to the importance of hypoalbuminaemia. Hypoalbuminaemia is associated with a poor surgical outcome and a longer stay in hospital and is a marker of higher risk in critically ill patients. It is associated with oedema and, …