Analbuminaemia. Clinical and laboratory features in a South African patient

A 10-year-old white boy suffering from primary analbuminaemia presented with a 6-month history of ankle oedema. From infancy he had suffered from asthma and respiratory tract infections. His somatic growth was retarded but his mental and motor development was normal. The plasma albumin level was markedly reduced (81 mg/l) but a number of other plasma protein levels showed compensatory increases above the normal range. A study of the binding of unconjugated bilirubin added to the patient's plasma in vitro revealed an accumulation within the high-density lipoprotein fraction. It is suggested that the relative absence of severe illness in analbuminaemia reflects similar compensatory mechanisms afforded by the increase in non-albumin plasma protein levels and by other metabolic adjustments.