Albumin, Serum
(Alb)

Sample type: -

Serum (preferred) or plasma (lithium heparin)

Uses: -

1. Evaluation of nutritional status, blood oncotic pressure; evaluation of renal disease with proteinuria and other chronic diseases.

2. High albumin may indicate dehydration. Look for increase in hemoglobin, hematocrit in such patients.

3. Low albumin is found with use of I.V. fluids, rapid hydration, overhydration; cirrhosis, other liver disease, including chronic alcoholism; in pregnancy and with oral contraceptive use; many chronic diseases including the nephrotic syndromes, neoplasia, protein-losing enteropathies (including Crohn’s disease and ulcerative colitis), peptic ulcer, thyroid disease, burns, severe skin disease, prolonged immobilization, heart failure, chronic inflammatory diseases such as the collagen diseases and other chronic catabolic states.

4. Starvation, malabsorption, or malnutrition:

• In the absence of I.V. fluid therapy and in patients without liver or renal disease, low albumin may be regarded as an indication of inadequate body protein reserves.

• It is described as the most common nutrition-related abnormality in patients with infection. Serum albumin has a half-life of about 18 to 20 days.

• Its half-life is decreased in patients with catabolic states: Infection and with protein loss through the kidneys (eg, nephrosis), gastrointestinal tract, and skin (eg, burns). Its prognostic application is most useful in patients with weight loss, anorexia, stress, surgical therapy, hemorrhage, and infection.

• Total iron binding capacity <240 μg/dL1 and/or low transferrin levels would support an impression of inadequate protein reserves. Absolute lymphocyte counts <1500/mm3 may also be seen with protein malnutrition.2 In severe malnutrition, albumin has been reported as <2.5 g/dL, total lymphocytes as <800/mm3 and TIBC as <150 μg/dL.2

1. Albumin levels ≤2.0−2.5 g/dL may be the cause of edema (eg, nephrotic syndrome, protein-losing enteropathies).

2. Albumin, prealbumin, and transferrin are regarded as “negative” acute phase reactants (ie, these proteins decrease with acute inflammatory/infectious processes).

3. Low albumin values are associated with longer hospital stay.

Precautions: -

You don’t need any special preparations to test for albumin in blood. If your health care provider has ordered other blood tests, you may need to fast (not eat or drink) for several hours before the test. Your health care provider will let you know if there are any special instructions to follow.

Interfere factor: -

Albumin is decreased in:

1. Pregnancy (last trimester, owing to increased plasma volume).

2. Oral birth control (estrogens) and other drugs.

3. Prolonged bed rest.

4. IV fluids, rapid hydration, overhydration.

Pre analytical error: -

• Patients eat too much protein before test.

• Patients must be fast.

• Fluoride plasma specimen; gross hemolysis; lipemia; improper labeling.

Corrective action: -

• Explain test purpose and specimen collection procedure.

• No fasting is required.

• Use red-top tube, gel-barrier tube, or green-top (lithium heparin) tube.

Post analytical error: -

• Increase levels of test.

• Send the result to the wrong patient.

corrective Action: -

• Low levels are associated with edema. Assess patient for these signs and symptoms.

• Be carful of the labeling and the report submission.

Reference range: -

• 0–4 months: 2.0–4.5 g/dL

• 4 months−16 years: 3.2–5.2 g/dL

• > 16 years: 3.5–4.8 g/dL