albumin hipoalbumin

8/12/2019 Albumin Hipoalbumin

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The concentration of albumin in lymph protein content is approximately %"7 that ofplasma.

Albumin Physiological Role

Albumin has a role in maintaining :


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Anticoagulant effectsThe anticoagulant and antithrombotic effects of albumin are poorly understood this maybe due to binding nitric oxide radicals inhibiting inactivation and permitting a moreprolonged anti0aggregatory effect. In diabetes, glycosylated albumin may increase theincidence of thrombotic events and atherosclerosis.

(ascular PermeabilityIt is possible that albumin has a role in limiting the lea#age from capillary beds duringstress induced increases in capillary permeability. This is related to the ability ofendothelial cells to control the permeability of their walls, and the spaces between them.

Albumin may plug this gap or may have a deflecting effect, owing to its negative charge.This has led to the hypotheis that colloids are effective at maintaining vasculararchitecture.

Albumin )ypoalbuminemia

*erum albumin concentration falls due to decreased synthesis, increasedcatabolism, increased loss and redistribution.

=lasma albumin concentration is calculated as6 intravascular albumin mass 1 plasmavolume

+auses of decreased plasma albumin6. ecreased synthesis.'. Increased catabolism @very slow2. Increased loss6

Bephrotic syndrome8xudative loss in burnsLaemorrhage*ut loss

3. 9edistribution6Laemodilution

Increased capillary permeability (lea#age into the interstitium)ecreased lymph clearance.

-:apillary lea# syndrome-J occurs in systemic inflammatory response syndrome.ue to widespread damage to the capillary endothelium, there is increased loss ofmedium to high molecular weigh compounds, particularly albumin, into the extravascularspace and therefore loss of the normal Ctarling relationship.hat diseases is hypoalbuminaemia associated -ithLypoalbuminemia is associated with liver and renal disease, =8T, CI9C 1 includingburns, trauma. Mow preoperative albumin is an indicator of poor outcome from surgery.Liver /ysfunction

Albumin is a poor mar#er of liver dysfunctionN prothrombin time is more reliable.Renal disease

Albumin loss occurs in nephropathies (nephrotic syndrome).There is a small loss of albumin in dialysis circuits.Pre#0clampsia 1P023In normal pregnancy there is an increase in plasma volume. In =8T there is aparadoxical decrease in plasma volume, widespread capillary lea# and albuminuria.*tress responseInterleu#ins cause a mar#ed decease in synthesis of plasma proteins other thanalbumin.


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In fact Albumin and Transferrins decrease in the stress response, a process oftentermed Hnegative acute phase proteinsH.IM& directly decreases the Oexpression of albumin messenger 9BA.


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2. >or volume replacement in cirrhosis (spontaneous bacterial peritonitis) - someevidence.

3. As the colloid of choice in infants - no evidence either way.$. In burns - no evidence either way.&. >ollowing paracentesis for ascites - no evidence./. To treat nephrotic syndrome - no evidence.

%. As a colloid agent in critical illness6 little supportive evidence.A meta0analysis by the :ochrane :ollaboration (4;R Rune !!%), has suggested thatthe administration of albumin may, in fact, worsen outcome. Shilst this paper washeavily criticied in terms of methodology and outcome measures, it has had asignificant impact on practice. A subse+uent widened meta0analysis (Sil#es ;; '"")found that albumin administration did not significantly alter outcome.The inclusion of albumin in -colloid versus crystalloid-J debates has led to claimsthat the latter are safer than the former. Lowever these papers demonstrate thesignificant wea#nesses that exists in the performance of meta0analysis and thegeographic bias in publication versus practice.hy -ould albumin be harmfulThere are concerns about the manufacturing process of commercially available albumin6

:ommercially available albumin is fractionated in ethanol and purified and heat treatedfor " hours at &"o:.This process6=robably alters the charge on albumin 0 ma#ing it more permeable.:ontains significant +uantities of residual ions 0 aluminum and vanadium.It appears that, without strong data supporting the use of this agent, and withalternatives available (hydroxyethyl starch), the continued prescription of albumin as avolume expander is neither clinically indicated nor cost effective. Bonetheless, there islittle evidence to re5ect the use of this agent in itEs conventional setting 0 as a volumeexpander in babies and in burns. :urrently, albumin is the fluid of choice in preventingrenal failure in patients with spontaneous bacterial peritonitis (Cort =, !!!).

Albumin 5ey Points. Albumin is the most abundant extracellular protein, it-Ds distribution is

primarily intravascular.'. Albumin has a role in maintaining :


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". There is no evidence that correcting hypoalbuminemia improves outcome,indeed therapeutic albumin administration may worsen outcome.

albumin hipoalbumin

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