Proven applications
Possible applications
Strong evidence
Lack of strong evidence but physiological rationale
Large-volume paracentesis
Recurrent ascites (as a long-term treatment)
Spontaneous bacterial peritonitis (SBP) with ascites
Non-SBP-related sepsis and infections
Hepatorenal syndrome (concomitantly with diuretics and/or vasoconstrictors)
Hypervolemic hyponatremia
Hepatic encephalopathy
Detoxification (as extracorporeal blood purification)
Table 6.2
Albumin functions
Main property | Its relation to albumin structure | Mechanism description |
|---|---|---|
Regulation of oncotic pressure | Constitutes 50 % of total plasma proteins Has net negative charge at physiological pH | Represents 70–80 % of the plasma oncotic pressure Increases intravascular blood volume |
Transportation and metabolism | Has net negative charge at physiological pH Has complex flexible tertiary structure with binding sites | Has capacity to bind various endo- and exogenous substances and molecules (bilirubin, metals, ions, hormones, amino acids, fatty acids, bile acids, nitric oxide, drugs, endotoxin) |
Additional property | ||
Capillary permeability stabilization | In 50 % is present in extravascular compartment | Influences vascular integrity |
Antioxidative effect | Contains sulfhydryl (thiol) groups | Scavenges free radicals Neutralizes ionic catalyzers (copper and iron) |
Hemostatic effect | Has complex flexible tertiary structure with binding sites | Binds and inactivates nitric oxide and arachidonic acid Interferes platelet aggregation Neutralizes factor Xa by AT |
Acid-base regulation | Has net negative charge at physiological pH | Buffers plasma |
Immunomodulation | Has complex flexible tertiary structure with binding sites Contains sulfhydryl (thiol) groups | Binds and inactivates endotoxin Inhibits and regulates production of TNF-α, NF-ĸB, complement factor C5a Interferes neutrophil adhesion |
Endothelial stabilization | Has complex flexible tertiary structure with binding sites Contains sulfhydryl (thiol) groups Has net negative charge at physiological pH | Regulates metabolic function of substances released to circulation Modulates inflammation and oxidative stress Inhibits apoptosis |
Pleiotropic effect | Has complex flexible tertiary structure with binding sites | Prevents myocardial damage Stabilizes endothelial cells |
6.4 Therapeutic Use
Albumin can be administrated via the transfusion of plasma products or HSA, which is preferred. There are several albumin solutions in the market: 4 %, 5 %, 20 %, and 25 %, containing 0.04 g, 0.05 g, 0.2 g, and 0.25 g of albumin per ml, respectively.
In healthy subjects, approximately 66 % of the extracellular albumin is in the interstitial space and only 1/3 in the intravascular space. The transfer from the intravascular to interstitial space is 4–5 % per hour, and approximately a parallel transfer exists from the interstitial compartment into the lymphatic system. In patients with liver cirrhosis who undergo albumin transfusion, those ratios are difficult to estimate because of a much more complex albumin metabolism which depends on the degree of organ failure and systemic inflammation. The therapeutic action of HSA in cirrhosis is believed to arise not only from the plasma volume expansion but also from the modulation of systemic and organ inflammation [6].
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