The therapeutic use of albumin
G. E. Hastings and P. G. Wolf
Department of Internal Medicine, University of Kansas School of Medicine-Wichita.
In this review, we condense and summarize the results of studies on the
therapeutic use of human albumin to promote the more efficient use of this
costly resource. Reports of major controlled and uncontrolled therapeutic
trials, reviews, and summary articles published in English between 1972 and
1991 were identified through library and MEDLINE searches. Case series,
prospective studies, and blinded therapeutic trials were identified from
the bibliographies of these sources. All sources were critically evaluated
for information about the comparative physiologic results and patient
outcomes of the therapeutic use of albumin solutions, crystalloid
solutions, and volume expanders other than albumin. The therapeutic use of
albumin is of marginal benefit for many conditions for which it has been
administered, apparently because of the body's capacity to quickly
compensate for rapid colloid osmotic shifts. Human studies show little or
no demonstrable value for albumin when it is administered for nutritional
supplementation, wound healing, perioperative fluid replacement, treatment
of early thermal injury, or therapy during extensive retroperitoneal
surgery (including aortic aneurysm resection). Therapeutic albumin has
well-defined value in several special circumstances: large-volume
paracentesis in cirrhotic patients, acute nephrotic syndromes with diuretic
resistance, organ transplantation, and plasmapheresis. Additional studies
are needed to compare the efficacy of albumin with other volume expanders.
For most purposes, balanced crystalloid solutions are satisfactory
substitutes for colloid volume expanders and can be obtained at a fraction
of the cost of colloid volume expanders.
