Albumin and globulin, it's hard to tell them apart (Part 1)

This is the 5128th article of Da Yi Xiao Hu

In our clinical work, we often encounter patients or their families asking: "Doctor, can you give our patients some albumin to improve their immunity and make them get better faster?" "Doctor, we need to use globulin. People say that with globulin, the disease will be cured quickly." "Doctor, protein is protein. I don't understand it. Anyway, it will be good if you use it." "Doctor, can't we buy protein with our own money?" "Doctor,..."

Doctors are often speechless. Whether it is albumin or globulin, its use must be in accordance with the indications. Moreover, most of the time, ordinary people do not understand what albumin and globulin are. Today, let's talk about albumin and globulin.

Let's talk about albumin first. First of all, the albumin that ordinary people call is called "human albumin". Human albumin (HA) is a blood product extracted and separated from the blood of healthy people. It is widely used in the clinical treatment of critically ill and seriously ill patients. In our country, the use of human albumin is very large, but there are also many unreasonable uses, such as not meeting the indications, too long a course of treatment, and using the drug beyond the instructions.

We already know that human albumin is extracted from the blood of healthy people. So what important role does albumin play in our body? Albumin is a multifunctional protein with the highest proportion in human plasma. It is synthesized and secreted into the blood by liver cells. In a healthy human body, the plasma albumin level is 35-55 g/L. Albumin is the main source of maintaining the colloidal osmotic pressure of our blood. It has the function of regulating the balance of fluid inside and outside blood vessels and maintaining blood volume. In addition, it has many physiological functions such as substance binding and transport, antioxidant effect, reducing inflammatory damage, immune regulation, maintaining endothelial function, reducing capillary permeability and neuroprotection. It is widely used in the treatment of various diseases.

Since albumin has so many uses, under what circumstances do we need to supplement human albumin? According to the "Chinese Expert Consensus on the Clinical Application Management of Human Albumin" compiled by the Hospital Pharmacy Committee of the Chinese Pharmaceutical Association, we can see that significant hypoalbuminemia, emergency treatment of insufficient blood volume, cirrhosis and its complications, treatment of neonatal hyperbilirubinemia, cardiopulmonary bypass, special types of hemodialysis, etc. are all indications for the use of human albumin, but the specific conditions and timing of use require clinical judgment by clinicians.

At present, the specifications of human albumin used clinically in my country are mainly 5%, 20% and 25%. Among them, 5% is an isotonic solution, while 20% and 25% are hyperosmotic solutions. Different specifications of human albumin have different effects and different focuses. The specific choice is left to the clinician to make according to the condition of the patient.

At the same time, we should note that because human albumin is a component extracted from human blood, the adverse effects of infusion are often unavoidable. About 0.1% of patients will experience allergic reactions, such as flushing, rash, fever, chills, nausea, vomiting, tachycardia and hypotension. Most of these symptoms improve and disappear as the infusion rate decreases or the infusion stops, but it is contraindicated for those with severe allergies. There is also a risk of infection with blood-borne diseases. Therefore, before use, doctors usually ask patients or family members to sign a consent form for the use of blood products. In addition, some patients with hypertension, acute heart failure, renal insufficiency, etc. should also be evaluated before considering use to avoid aggravating the symptoms of the primary disease.

Author: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Emergency Department Liu Li