Human albumin is available as 5% (osmotic and oncotic equivalent of plasma) or 25% solutions obtained by fractionation and viral inactivation of large volumes of pooled plasma. It should be stored according to manufacturer recommendations.
Indications for human albumin transfusion:
1) Large-volume paracentesis (>5 L).
2) Fluid replacement in plasma exchange.
3) Possibly beneficial in patients with hepatorenal syndrome, spontaneous bacterial peritonitis, and cirrhosis.
In patients with hypovolemia or hypovolemic shock, there is no evidence demonstrating the superiority of blood volume replacement with albumin over crystalloid solutions; crystalloids should be used as first line. Although albumin has been used to aid in intravascular volume repletion and for the management of hypoalbuminemia in patients with cirrhosis, as well as for the management of hypoalbuminemia in general, there is little data to support this strategy.
For fluid replacement following paracentesis, 25% albumin may be dosed as 200 mL (if the volume of ascites is 5-8 L), 300 mL (ascites volume, 8-12 L), or 400 to 500 mL (ascites volume, 12-15 L). No blood crossmatching is required prior to albumin administration.