Synonym

• Serum albumin
• Alb

Tubes

• Red, tiger or light green top tube.
• 5 mL of venous blood (may use a little as 1 mL if quantity difficult to obtain).

Additional information

• The tourniquet should not be left on the arm for longer than 60 seconds
• Handle sample gently to prevent hemolysis
• Send the sample to lab within 4 hrs

Info

• Serum total protein consists albumin and globulin
• Albumin is the major component of total proteins, synthesized mainly in the liver, and maintains colloidal osmotic pressure in both the intravascular and extravascular spaces

Clinical

The indication for testing albumin depends upon the clinical scenario.

• Assessment of nutritional status (malnutrition will have decreased albumin)
• Assessment of losses of albumin (burns, renal or GI losses)
• Assessment of fluid status (hypervolemia such as in ascites or CHF may result in decreased levels)
• Assessment of liver disease (poorly functioning liver will have diminished albumin production)

The effects of a low albumin are typically that of intravascular fluid leaking into tissues with ascites and/or edema resulting.

Additional facts:

1. Serum albumin level is affected by the body position. Specimens collected with the patient in an upright position show higher values than those collected in a supine position.
2. Serum albumin levels may affect the bioavailability of certain medications.
3. In the geriatric population, hypoalbuminemia is an independent risk factor for all cause mortality. Geriatric patients admitted to the hospital with low albumin have worse outcomes than those with normal levels.

Nl Result

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

	Conv. Units (g/dL)	SI Units (g/L)
Adult	3.1-5.0	31-50
5-18	3.0-5.6	30-56
5 yrs	2.8-4.4	28-44

See test

High Result

High serum albumin levels may be seen in conditions of decreased plasma water [e.g. dehydration, shock (hypovolemic), hemoconcentration].

See test

Low Result

Low serum albumin levels may be seen in:

I. Decreased production of albumin

• Amyloidosis
• Congenital analbuminemia (very rare)
• Liver disease (Cirrhosis, Alcoholism, Hepatitis)
• Malnutrition (Starvation, Malabsorption)
• Sarcoidosis

II. Increased plasma water

• Congestive heart failure
• Monoclonal gammopathies (Waldentrom's, Myeloma)
• Overhydration
• Pregnancy

III. Losses of albumin

• Burns
• GI disease with losses (Crohn's, Ulcerative colitis, Celiac Sprue, Whipple's disease, diarrheal illnesses)
• Renal (Glomerulonephritis, Nephrotic syndrome)
• Repeated thoracentesis or paracentesis
• Severe dermatologic disease

IV. Other

• Bacterial or Parasitic infections
• Bed rest (Prolonged)
• Cushing's disease
• Leukemia
• Lupus
• Rheumatoid arthritis
• Thyroid disease
• Thyrotoxicosis
• Toxemia of pregnancy/Preeclampsia
• Various Cancers

V. Medications

• Acetaminophen (very high doses)
• Androgens
• Corticosteroids (e.g. Prednisone)
• Dapsone
• Dextran
• Estrogens
• Growth hormone
• Ibuprofen
• Insulin
• Nitrofurantoin
• Oral contraceptives
• Phenytoin
• Steroids (Anabolic)
• Trazodone
• Valproic acid

See test

References

• Corti MC, Guralnik JM, Salive ME et al. Serum albumin level and physical disability as predictors of mortality in older persons. JAMA 1994; 272(13):1036-42.
• De Luis DA, Tzaola O, Cuellar L, et al. Nutritional Assessment: Predictive Variables at Hospital Admission Related with Length of Stay. Ann Nutr Metab. 2006 Jun 30;50(4):394-398[Epub ahead of print]
• Garcia-Campos M. Low Serum Albumin Levels as a Strong Factor to Develop Mucositis in Hematopoietic Transplants. Final Results. Presented at 2001 American Society of Clinical Oncology (ASCO) Annual Meeting. Abstract No. 1767.
• Kim AH, Oh KH, Yoon JW et al. Impact of Burn Size and Initial Serum Albumin Level on Acute Renal Failure Occurring in Major Burn. American Journal of Nephrology 2003;23:55-60.
• Lab Tests Online ®. Albumin. [Home page on the Internet]©2001-2006 [Last updated February 24, 2006] [Last accessed on July 13, 2006] Available at URL: http://www.labtestsonline.org/understanding/analytes/albumin/glance.html
• Laboratory Corporation of America®. Albumin, Serum. [Home page on the Internet]©2003 [Last updated November 11, 2005] [Last accessed on July 13, 2006] Available at URL: http://www.labcorp.com/datasets/labcorp/html/chapter/mono/pr000300.htm
• Law MR, Morris JK, Wald NJ and Hale AK. Serum albumin and mortality in the BUPA Study. International Journal of Epidemiology. 1994; 23(1):38-41.
• MedlinePlus Medical Encyclopedia ®. Albumin-Serum. [Home page on the Internet]©2005 [Last updated February 14, 2005] [Last accessed on July 13, 2006] Available at URL: http://www.nlm.nih.gov/medlineplus/ency/article/003480.htm
• Schalk BWM, Deeg DJH, Penninx BWH et al. Serum Albumin and Muscle Strength: A Longitudinal Study in Older Men and Women. J Am Ger Soc. 2005; 53 (8): 1331.
• Vishwanathan V, Snehalata C, Kumutha R et al. Serum albumin levels in different stages of type 2 diabetic nephropathy patients. Indian J Nephrol 2004; 14: 89-92.
• Wick MJ, Wilkens K and Moritz J. Albumin Testing Methods Differ: Implications for the Dialysis Patient. Dialysis & Transplantation, Volume 23, Number 6, June 1994 Page 282.