Albumin deficiency: Description, Causes and Risk Factors
Albumin is a kind of water-soluble protein which is found in numerous forms in the natural world. It is an essential protein which is very important to maintain good health of living organisms. A number of plants and animals have albumin in them or may secrete the same in the form of waste. In human beings, it is present in the blood as well as the urine. It is synthesized in the liver and catabolized by all metabolically active tissues. Albumin makes a large contribution to plasma colloid osmotic pressure due to its small size and abundance (35-50% of total plasma proteins by weight). It also serves as a carrier protein for many insoluble organic substances (e.g., unconjugated bilirubin).
Albumin is an essential component of the blood. That is why its deficiency can lead to many medical problems. Besides a diet which is low in protein, there are a number of other causes behind low albumin levels in the blood:
- Infections such as those in the foot, teeth or gums.
- Bladder infections.
- Inflammations such as lupus and arthritis.
- A person who is suffering from health conditions such as liver problems, kidney diseases, and metabolic acidosis will present himself with low levels of albumin.
- Other health conditions such as Crohn's disease, in which the body is not able to absorb or digest proteins.
- Acute phase reactions stimulate downregulation of albumin production. An acute phase reactant response is initiated in response to trauma, inflammation, neoplasia, etc and involves a release of cytokines (IL-1, IL-6, TNF) from macrophages. These cytokines act on regulatory elements in hepatocyte genes, resulting in upregulation of transcription of acute phase reactant proteins (fibrinogen, serum amyloid A, ceruloplasmin, haptoglobin) and downregulation of transcription of other proteins, including albumin and transferrin (so-called "negative acute phase reactants"). Increased degradation of albumin may also play a role in the albumin deficiency in this reaction. In this case, the A:G is decreased due to the combination of low albumin and high globulins.
Albumin deficiency is more frequent in older patients who are institutionalized, patients who are hospitalized with advanced stages of disease (eg, terminal cancer), and malnourished children.
You may not have any symptoms unless your blood albumin levels are significantly lowered. In this case, you may not be eating very well. You may have swelling that is all over your body, or swelling in one part of your body (such as your legs). You may have muscle weakness, fatigue, or cramps. You may have a poor appetite, and may not be eating well. Even people who take in a lot of protein in their diet may still have low albumin levels in their blood.If you have liver problems that may have caused your albumin deficiency, you may notice that your abdomen is swollen with fluid (called, ascites).
Clinical suspicion of the underlying disease process should guide appropriate laboratory studies, some of which are outlined below.
Malnutrition: Lymphocyte count and blood urea nitrogen (BUN) levels are decreased. Transferrin, prealbumin, and retinol-binding protein have shorter half-lives compared with albumin and better reflect short-term changes in nutritional status than albumin, which has a long half-life.
- Inflammation: C-reactive protein levels and increased erythrocyte sedimentation rate (ESR) are elevated.
- Nephrotic syndrome: The 24-hour urine collection contains more than 3g of protein in 24 hours.
- Cirrhosis: Liver function test findings (transaminase levels) may be elevated or normal in patients who are cirrhotic. Coagulation studies may be abnormal. Cirrhosis has numerous potential etiologies, and more specific studies, such as hepatitis screening, may be needed.
- Malabsorption: Fecal fat studies including Sudan qualitative stain for fat, 72-hour quantitative fecal fat collection, and fecal a-1-antitrypsin clearance are needed.
- Serum protein electrophoresis results help to determine if hypergammaglobulinemia is present.
- None of the various correction factors for determining the effects of albumin deficiency on the plasma calcium concentration has proven reliable. Corrected calcium (mg/dL) is equal to measured total calcium (mg/dL) plus 0.8 (average normal albumin level of 4.4 minus serum albumin [g/dL]). The only method of identifying true (ionized) hypocalcemia in the presence of hypoalbuminemia is to measure the ionized fraction directly.
Elderly patients living in nursing homes or other institutionalized settings who have albumin deficiency should be evaluated for treatable co-morbid conditions contributing to the malnutrition (eg, medications causing decreased appetite, thyroid dysfunction, diabetes, malabsorption, depression, cognitive impairment).
Low blood albumin levels cannot be corrected by simply prescribing an albumin supplement to raise blood levels of the protein. In fact, some studies indicate that it might even be harmful to administer albumin as part of treatment. The optimum treatment for people with hypoalbuminemia is dependent on the cause of the condition. Low blood albumin levels are treated by managing the cause. Therefore, a patient being treated for this condition might consult with a surgeon, nephrologist, cardiologist or another type of doctor, depending on the cause.
In patients who are critically ill, low calcium levels can be simply due to albumin deficiency, which has no clinical significance because the active fraction (ionized) is not affected. However, to prevent missing a second hypocalcemic disorder, measure the ionized calcium level whenever the albumin level is low.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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