Serum albumin: New thoughts on an old treatment

Abstract

Background:A review of serum albu- min use in BC was undertaken to gain insight into why albumin is be - ing used and to identify specialties using albumin most commonly. Methods:All BC hospitals were invit- ed to collect data on albumin use for 1 month to 3 months in 2003. A form completed for each order of albumin recorded the product ordered, the specialty of the ordering physician, the indication for use, and the pa - tient's diagnosis and serum albumin level. Thirteen hospitals participat- ed in the study, representing 89% of total provincial albumin use. Data were sent to the Provincial Blood Coordinating Office for analysis. Results: The most common indica- tions for albumin use were hypoten- sion in hemodialysis (18.9%), volume replacement/expansion (15.0%), and hypoalbuminemia (14.8%), followed by plasmapheresis (6.3%), volume ex - pansion after cardiac surgery (5.6%), and pump priming for cardiac surgery (5.3%). Nephrology was the special- ty demonstrating the largest single proportion of provincial albumin use at 20.3%, followed by internal medi- cine (15.1%), general surgery (12.1%), and cardiac surgery (10.8%). Other specialties demonstrating moderate albumin use were anesthesiology (7.1%), gastroenterology (6.6%), and critical care medicine (5.9%). The relative proportion of albumin used by each specialty varied across the hospitals studied. Conclusions: The interhospital dif- ferences in use suggest practice variations within BC, and the use of albumin for indications that litera- ture-based guidelines in other juris- dictions have found unsupportable suggests some prescriptions are in - appropriate. Practice variations could be minimized and albumin used more appropriately with the intro- duction of guidelines and education strategies regarding the use of albu- min and other volume expanders.