Albumin: don't confuse us with the facts

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7162.829 (Published 26 September 1998) Cite this as: BMJ 1998;317:829

Rather than fulminating, seek to answer the questions raised

  1. Brian McClelland, Director
  1. Department of Transfusion Medicine, Royal Infirmary, Edinburgh EH3 9HB

    Letters p 882

    Goodness, what a reaction. You would think that the Cochrane Injuries Group had really gone too far with its systematic reviews of the outcomes in patients treated with colloid solutions and human albumin. 1 2 Worse, the BMJ has colluded in publicising this dangerously subversive material. One couldn't miss the incandescent letters that these rather routine, workmanlike reviews have elicited (p 882). 3 4 It's as though they had desecrated Osler's grave.

    So what is going on here? Scepticism about most uses of albumin is not new5 and is reflected in clinical guidance in the United Kingdom.6 The new factor is that a group that is expert in the business of finding and sifting clinical evidence has revisited this aspect of the crystalloid v colloid argument that has been grumbling on since the Vietnam war. The authors are not clinical experts in emergency medicine, burns, or intensive care and don't claim to be. All they have done is unearth all the papers that compare mortality in patients treated with albumin according to licensed indications,7 line up the results according to a defined set of criteria, and write down what they found. Capable patients or their lawyers might reasonably tackle a project like this.

    Moreover, the authors' discussion and conclusions about …

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