Makindo Medical Notes

💉 Human Albumin Solution (HAS) is issued by the Trust blood bank. Like other plasma products, it is derived from fractionation of donated whole blood and is subject to the same traceability, consent, and reporting requirements. Patients who decline blood products (e.g. for religious reasons) may also refuse albumin. ✅

ℹ️ About

Always check the BNF link here 📖 for prescribing advice.

• Colloidal fluid used selectively in specific clinical contexts, not routinely to “boost albumin levels.”

⚙️ Mode of Action

• 4.5% HAS: iso-oncotic (≈plasma oncotic pressure). Used as a volume expander in acute illness 💧.
• 20% HAS: hyperoncotic, draws interstitial fluid into intravascular space. Useful in paracentesis, SBP, hepatorenal syndrome.

💊 Indications & Dosing

• Volume expansion (4.5% HAS): burns, pancreatitis, trauma, perioperative complications (with crystalloids).
• Large-volume paracentesis (ascites drainage): 8 g albumin for each litre removed. → Give 100 mL of 20% HAS for every 3 L ascitic fluid drained (infuse over ≥2 h).
• Spontaneous bacterial peritonitis (SBP): • Day 1: 1.5 g/kg 20% HAS • Day 3: 1 g/kg 20% HAS, continue until improvement.
• Hepatorenal syndrome (HRS): • Day 1: 1 g/kg 20% HAS • Day 2–14: 0.5 g/kg/day until clinical improvement.

🚫 Not Indicated

• Routine daily infusions in advanced liver cirrhosis offer no added benefit over standard care.
• Not recommended solely to correct hypoalbuminaemia in chronic liver disease.

⚠️ Interactions

• See BNF.

🔎 Cautions

• Risk of fluid overload and precipitating heart failure or pulmonary oedema 🫁.
• 20% HAS is hyperoncotic → expands plasma volume significantly.
• Always issued on a named patient basis via blood bank.

🚫 Contraindications

• See BNF.

❗ Side Effects

• Circulatory overload (↑ risk in elderly or cardiac dysfunction).
• Infusion reactions / hypersensitivity.
• Theoretical risk of transmission of nvCJD (prion disease).

📚 References

• Human albumin in the management of complications of liver cirrhosis
• UK Guideline for the use of human albumin solution (HAS)

📝 Revisions

• Expanded clinical uses, added SBP/HRS regimens and safety cautions.