Clinical indications for human serum albumin

Three indications have been considered for the clinical use of human serum albumin: nutrition, binding and transport, and the volume effect due to the oncotic properties of the protein. The use of albumin as an intravenous nutrient is clearly inappropriate. The literature on its binding and transport properties is as yet clinically inconclusive, and it seems premature to enforce product specifications based on these characteristics. The effects on blood volume and hypoproteinemia are firmly established in patients with an intact capillary system. The therapeutic implications of a capillary "permeability lesion" are a subject of current debate. Such lesions occur following extensive injuries and in patients with septic pulmonary failure. Although the data are contradictory, it is largely agreed that the serum albumin level should be kept above 30 g/litre or the total serum protein above 50 g/litre.