Albumin

Albumin

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The reference range for albumin testing is as follows:^{[1, 2]}

The normal range is 3.5 to 5.5 g/dL or 35-55 g/liter. This range may vary slightly in different laboratories.

Albumin composes 50%-60% of blood plasma proteins.

An image depicting human serum albumin can be seen below.

The albumin test measures the amount of albumin in the clear liquid portion of blood.

Conditions associated with “high” levels of albumin: dehydration.

Conditions associated with “low” levels of albumin are as follows:

Ascites

Burns

Glomerulonephritis^[3]

Liver disease (hepatitis or cirrhosis)

Malabsorption syndromes (eg, Crohn disease, celiac disease, or Whipple disease)

Malnutrition

Other states are as follows:

Nephropathy

Hepatic encephalopathy

Hepatorenal syndrome

Sprue

Wilson disease

Details are as follows:

Specimen type: Blood

Container: Vacuum tubes

Collection method: Venipuncture

Albumin Tester: A digital sensing platform running on a smart phone.^[4]

Albumin testing is part of a comprehensive metabolic panel. The liver panel is a related test.

Albumin is a blood plasma protein synthesized in the liver. It is the single most abundant protein in plasma and constitutes about two-thirds of total protein content. Because it is the main protein in human blood, decreases in albumin due to decreased synthesis or losses result in impaired regulation of intravascular oncotic pressure and manifests as edema. As such, it transports certain hormones (eg, thyroid, estrogen, cortisol) when their specific binding globulins are saturated, unconjugated bilirubin and other organic anions, and many drugs (eg, penicillin, warfarin). Albumin is soluble in water, precipitated by acid, and coagulated by heat. The chief functions of albumin are to transport a wide variety of ligands, to maintain plasma oncotic pressure, and to serve as a source for endogenous amino acids.^{[1, 2]}

Several methods exist for determining albumin levels, including dye-binding methods, electrophoresis, and immunochemical methods, as well as dipstick methods for urinary albumin.

For the determination of albumin in serum/plasma, the patient should stop taking drugs that affect albumin measurements, such as anabolic steroids, androgens, growth hormones,^[5]and insulin.

A blood sample is put in a centrifuge, which spins and separates the cells from the serum.

The albumin test helps to determine if the patient has liver or kidney disease or if the body is not absorbing enough protein.

Indications for the albumin test are as follows:

Jaundice^[6]

Fatigue

Weight loss

Symptoms of nephrotic syndrome (swelling around eyes, belly, or legs)

Causes of changes in albumin levels are as follows:

Decreased production (low protein diet or malnutrition, malabsorption)

Cirrhosis of the liver

Excess excretion by the kidneys (ascites or protein-losing nephropathy or enteropathy)^[7]

Prolonged diarrhea

Loss from skin through burns

See the list below:

Albumin production is decreased during pregnancy.

Patients taking large amounts of intravenous fluids may have inaccurate results.

The test may need to be performed with creatinine and blood urea nitrogen tests to evaluate kidney function.^[8]

This test may need to be performed with a prealbumin test to evaluate nutritional status.

Marked lipemia can interfere with albumin measurement.

Burtis CA, Ashwood MD. Tietz Textbook of Clinical Chemistry. 3rd ed. Saunders; 1999.

McPherson RA, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods: Expert Consult – Online and Print. 22nd ed. Saunders; 2011.

Kirac Y, Bilen S, Duranay M. Comparison of laboratory findings in patients with glomerulonephritis classified according to histopathologic diagnosis. Minerva Med. 2014 Apr. 105(2):149-56. [Medline].

Coskun AF, Nagi R, Sadeghi K, Phillips S, Ozcan A. Albumin testing in urine using a smart-phone. Lab Chip. 2013 Nov 7. 13(21):4231-8. [Medline]. [Full Text].

Rasmussen MH, Brændholt Olsen MW, Alifrangis L, Klim S, Suntum M. A Reversible Albumin-binding Growth Hormone Derivative is Well-tolerated and Possesses a Potential Once-weekly Treatment Profile. J Clin Endocrinol Metab. 2014 Jul 11. jc20141702. [Medline].

Xu B, Yu HB, Hui W, He JL, Wei LL, Wang Z, et al. Clinical features and risk factors of acute hepatitis E with severe jaundice. World J Gastroenterol. 2012 Dec 28. 18(48):7279-84. [Medline]. [Full Text].

Ni Z, Yuan Y, Wang Q, Cao L, Che X, Zhang M, et al. Time-averaged albumin predicts the long-term prognosis of IgA nephropathy patients who achieved remission. J Transl Med. 2014 Jul 10. 12(1):194. [Medline]. [Full Text].

Robb A, Ffrench-Constant A, Morris R, Denison F, Stock S. PMM.43 The Predictive Value of Urinary Albumin: Creatinine Ratio In Pregnancy. Arch Dis Child Fetal Neonatal Ed. 2014 Jun. 99 Suppl 1:A137. [Medline].

Sridevi Devaraj, PhD, DABCC, FACB Medical Director of Clinical Chemistry and POCT, Texas Children’s Hospital; Professor of Pathology and Immunology, Baylor College of Medicine; Associate Director of Translation, Texas Children’s Microbiome Center

Disclosure: Nothing to disclose.

Thomas M Wheeler, MD Chairman, Department of Pathology and Immunology, WL Moody, Jr, Professor of Pathology, Professor of Urology, Baylor College of Medicine

Thomas M Wheeler, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Medical Association, American Society for Clinical Pathology, American Society of Cytopathology, American Thyroid Association, American Urological Association, College of American Pathologists, United States and Canadian Academy of Pathology, International Society of Urological Pathology, Harris County Medical Society