[Guidelines on therapy with blood components and plasma derivatives: human albumin. Recommendations of the scientific advisory board of the Medical Council].
Human albumin (HA) is by far the most expensive option for volume replacement and correction of hypoalbuminemia but is still widely used. The value of HA in the clinical setting continues to be controversial and it remains unclear whether there is still a place for using such a high-priced substance in the present cost-consciousness climate. Thus the Medical Council has presented some recommendations with regard to blood and plasma products including HA. There appear to be no indications for HA to correct hypovolemia either perioperatively or in the intensive care setting including children and patients undergoing cardiac or liver surgery. For maintaining colloid oncotic pressure (COP) cheaper modern synthetic colloids can be alternatively given and the value of HA for correcting hypoalbuminemia is also not clearly justified. Some small uncontrolled studies have shown that only patients with liver cirrhosis, spontaneous bacterial peritonitis and massive ascites drainage may profit from HA. Theoretical benefits such as oxygen radical scavenging or binding of toxic substances are no indications for using HA as beneficial clinical consequences have not yet been demonstrated. Experimental data from cell lines or animals must be viewed with skepticism because they do not mimic the clinical setting. According to the recommendations of the scientific advisory board of the Medical Council the use of HA should be considered very cautiously.
Boldt
J
J
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen, Deutschland. BoldtJ@gmx.net
D000418:Albumins / Q000191:economics / Q000627:therapeutic use*; D016913:Blood Component Transfusion / Q000592:standards*; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D003365:Costs and Cost Analysis; D003422:Critical Care; D017408:Guidelines as Topic; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000628:therapy; D020896:Hypovolemia / Q000628:therapy; D010952:Plasma Substitutes / Q000191:economics / Q000627:therapeutic use*
D000418:Albumins; D010952:Plasma Substitutes