Practice Guideline

. 2024 Aug;166(2):321-338.

doi: 10.1016/j.chest.2024.02.049. Epub 2024 Mar 4.

Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines

Jeannie Callum¹, Nikolaos J Skubas², Aarti Bathla³, Homa Keshavarz³, Edward G Clark⁴, Bram Rochwerg⁵, Dean Fergusson⁶, Sesmu Arbous⁷, Seth R Bauer⁸, Louise China⁹, Mark Fung¹⁰, Rachel Jug¹¹, Michael Neill¹², Cary Paine¹³, Katerina Pavenski¹⁴, Prakesh S Shah¹⁵, Susan Robinson¹⁶, Hua Shan¹⁷, Zbigniew M Szczepiorkowski¹⁸, Thierry Thevenot¹⁹, Bovey Wu²⁰, Simon Stanworth²¹, Nadine Shehata²²; International Collaboration for Transfusion Medicine Guidelines Intravenous Albumin Guideline Group

Collaborators, Affiliations

Collaborators

International Collaboration for Transfusion Medicine Guidelines Intravenous Albumin Guideline Group:
Jerome Flores²³, Stéfanie Frappier²⁴, Yvette Hou²⁵, Lilly Jean-Pierre²⁶, Danny Jomaa²⁷, Monisha Kabir²⁸, Leo Kadota²⁹, Michelle Lam³⁰, David A Ripsman³¹, Ryan Sandarage²⁹, Emiliyan Staykov³², Angelica Venes³³, Melissa Wan³⁴, Arwa Al Riyami³⁵, Shubha Allard³⁶, Melissa Brouwers³⁷, Jeannie Callum³⁸, James Daly³⁹, Gregory A Denomme⁴⁰, Lise Estcourt⁴¹, Dean Fergusson⁴², Mark Fung⁴³, Laura Green³⁶, Andreas Greinacher⁴⁴, Heather Hume⁴⁵, Rachel Jug⁴⁶, Richard Kaufman⁴⁷, Hyungsuk Kim⁴⁸, Vernon Louw⁴⁹, Tadashi Matsushita⁵⁰, Michael Murphy⁵¹, Joanne Pink³⁹, Susan Robinson⁵², Cynthia So-Osman⁵³, Simon Stanworth⁵⁴, Zbigniew M Szczepiorkowski⁵⁵, Aaron Tobian⁵⁶, Erica Wood⁵⁷

Affiliations

¹ Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada. Electronic address: jlc17@queensu.ca.
² Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
³ Canadian Blood Services, Ottawa, ON, Canada.
⁴ Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Department of Medicine and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁶ Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
⁹ Department of Hepatology and Institute for Liver and Digestive Health, The Royal Free NHS Trust and University College London, London, England.
¹⁰ Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT.
¹¹ University of Cincinnati College of Medicine, Cincinnati, OH.
¹² Patient representative.
¹³ Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
¹⁴ Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁵ Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁶ Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, England.
¹⁷ Department of Pathology, Stanford University School of Medicine, Palo Alto, CA.
¹⁸ Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
¹⁹ Service d'Hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France.
²⁰ Department of Internal Medicine, Graduate Medical Education, Loma Linda University, Loma Linda, CA.
²¹ NHS Blood and Transplant, Oxford, England; Radcliffe Department of Medicine, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
²² Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada; Transfusion Medicine Laboratory, Mount Sinai Hospital, Toronto, ON, Canada.
²³ University Health Network, Toronto.
²⁴ University of Ottawa, Ottawa.
²⁵ Trillium Health Partners.
²⁶ Carleton University.
²⁷ School of Medicine, Queen's University, Kingston.
²⁸ Bruyère Research Institute, Ottawa.
²⁹ Faculty of Medicine, University of British Columbia.
³⁰ CHEO ED SUPPORT Program, Carleton University.
³¹ Department of Neurology, Faculty of Medicine, University of British Columbia.
³² Michael G. DeGroote School of Medicine, Hamilton.
³³ Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa.
³⁴ Department of Family Medicine, Queen's University, Kingston.
³⁵ Sultan Qaboos University Hospital, Oman.
³⁶ National Health Service Blood & Transplant, United Kingdom.
³⁷ University of Ottawa, Canada.
³⁸ Sunnybrook Health Sciences Centre and University of Toronto, Canada.
³⁹ Australian Red Cross Lifeblood, Australia.
⁴⁰ Versiti Blood Centre of Wisconsin, United States.
⁴¹ National Health Services Blood & Transplant, United Kingdom.
⁴² Ottawa Hospital Research Institute, Canada.
⁴³ University of Vermont Medical Center, United States.
⁴⁴ University of Greifswald.
⁴⁵ University of Montreal, Canada.
⁴⁶ Canadian Blood Services, Canada.
⁴⁷ Brigham & Woman's Hospital Adult Transfusion Service, United States.
⁴⁸ Seoul National University Hospital, Korea.
⁴⁹ Groote Schuur Hospital, University of Cape Town, South Africa.
⁵⁰ Nagoya University Hospital, Japan.
⁵¹ University of Oxford and National Health Service Blood & Transplant, United Kingdom.
⁵² Guy's and St. Thomas' NHS Foundation Trust, United Kingdom.
⁵³ Sanquin and Erasmus Medical Center, The Netherlands.
⁵⁴ NHS Blood and Transplant and Oxford University, United Kingdom.
⁵⁵ Dartmouth-Hitchcock Medical Center, United States.
⁵⁶ Johns Hopkins University, United States.
⁵⁷ Monash University, Australia.

PMID: 38447639
PMCID: PMC11317816
DOI: 10.1016/j.chest.2024.02.049

Practice Guideline

Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines

Jeannie Callum et al. Chest. 2024 Aug.

. 2024 Aug;166(2):321-338.

doi: 10.1016/j.chest.2024.02.049. Epub 2024 Mar 4.

Authors

Collaborators

International Collaboration for Transfusion Medicine Guidelines Intravenous Albumin Guideline Group:
Jerome Flores²³, Stéfanie Frappier²⁴, Yvette Hou²⁵, Lilly Jean-Pierre²⁶, Danny Jomaa²⁷, Monisha Kabir²⁸, Leo Kadota²⁹, Michelle Lam³⁰, David A Ripsman³¹, Ryan Sandarage²⁹, Emiliyan Staykov³², Angelica Venes³³, Melissa Wan³⁴, Arwa Al Riyami³⁵, Shubha Allard³⁶, Melissa Brouwers³⁷, Jeannie Callum³⁸, James Daly³⁹, Gregory A Denomme⁴⁰, Lise Estcourt⁴¹, Dean Fergusson⁴², Mark Fung⁴³, Laura Green³⁶, Andreas Greinacher⁴⁴, Heather Hume⁴⁵, Rachel Jug⁴⁶, Richard Kaufman⁴⁷, Hyungsuk Kim⁴⁸, Vernon Louw⁴⁹, Tadashi Matsushita⁵⁰, Michael Murphy⁵¹, Joanne Pink³⁹, Susan Robinson⁵², Cynthia So-Osman⁵³, Simon Stanworth⁵⁴, Zbigniew M Szczepiorkowski⁵⁵, Aaron Tobian⁵⁶, Erica Wood⁵⁷

Affiliations

¹ Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada. Electronic address: jlc17@queensu.ca.
² Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
³ Canadian Blood Services, Ottawa, ON, Canada.
⁴ Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ Department of Medicine and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁶ Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
⁹ Department of Hepatology and Institute for Liver and Digestive Health, The Royal Free NHS Trust and University College London, London, England.
¹⁰ Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT.
¹¹ University of Cincinnati College of Medicine, Cincinnati, OH.
¹² Patient representative.
¹³ Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
¹⁴ Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁵ Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁶ Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London, England.
¹⁷ Department of Pathology, Stanford University School of Medicine, Palo Alto, CA.
¹⁸ Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
¹⁹ Service d'Hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France.
²⁰ Department of Internal Medicine, Graduate Medical Education, Loma Linda University, Loma Linda, CA.
²¹ NHS Blood and Transplant, Oxford, England; Radcliffe Department of Medicine, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
²² Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada; Transfusion Medicine Laboratory, Mount Sinai Hospital, Toronto, ON, Canada.
²³ University Health Network, Toronto.
²⁴ University of Ottawa, Ottawa.
²⁵ Trillium Health Partners.
²⁶ Carleton University.
²⁷ School of Medicine, Queen's University, Kingston.
²⁸ Bruyère Research Institute, Ottawa.
²⁹ Faculty of Medicine, University of British Columbia.
³⁰ CHEO ED SUPPORT Program, Carleton University.
³¹ Department of Neurology, Faculty of Medicine, University of British Columbia.
³² Michael G. DeGroote School of Medicine, Hamilton.
³³ Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa.
³⁴ Department of Family Medicine, Queen's University, Kingston.
³⁵ Sultan Qaboos University Hospital, Oman.
³⁶ National Health Service Blood & Transplant, United Kingdom.
³⁷ University of Ottawa, Canada.
³⁸ Sunnybrook Health Sciences Centre and University of Toronto, Canada.
³⁹ Australian Red Cross Lifeblood, Australia.
⁴⁰ Versiti Blood Centre of Wisconsin, United States.
⁴¹ National Health Services Blood & Transplant, United Kingdom.
⁴² Ottawa Hospital Research Institute, Canada.
⁴³ University of Vermont Medical Center, United States.
⁴⁴ University of Greifswald.
⁴⁵ University of Montreal, Canada.
⁴⁶ Canadian Blood Services, Canada.
⁴⁷ Brigham & Woman's Hospital Adult Transfusion Service, United States.
⁴⁸ Seoul National University Hospital, Korea.
⁴⁹ Groote Schuur Hospital, University of Cape Town, South Africa.
⁵⁰ Nagoya University Hospital, Japan.
⁵¹ University of Oxford and National Health Service Blood & Transplant, United Kingdom.
⁵² Guy's and St. Thomas' NHS Foundation Trust, United Kingdom.
⁵³ Sanquin and Erasmus Medical Center, The Netherlands.
⁵⁴ NHS Blood and Transplant and Oxford University, United Kingdom.
⁵⁵ Dartmouth-Hitchcock Medical Center, United States.
⁵⁶ Johns Hopkins University, United States.
⁵⁷ Monash University, Australia.

PMID: 38447639
PMCID: PMC11317816
DOI: 10.1016/j.chest.2024.02.049

Abstract

Background: Albumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis.

Study design and methods: Cochairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development, and Evaluation methodology. The guidelines were revised after public consultation.

Results: The panel made 14 recommendations on albumin use in adult critical care (three recommendations), pediatric critical care (one recommendation), neonatal critical care (two recommendations), cardiovascular surgery (two recommendations), kidney replacement therapy (one recommendation), and complications of cirrhosis (five recommendations). Of the 14 recommendations, two recommendations had moderate certainty of evidence, five recommendations had low certainty of evidence, and seven recommendations had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin commonly is transfused.

Interpretation: Currently, few evidence-based indications support the routine use of albumin in clinical practice to improve patient outcomes. These guidelines provide clinicians with actionable recommendations on the use of albumin.

Keywords: guideline; intensive care; intravenous albumin; kidney replacement therapy; liver disease; sepsis.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: J. C. receives research support from Canadian Blood Services and Octapharma and serves on the board of directors of the Canadian Hematology Society. N. J. S. is a director of the National Board of Echocardiography and receives royalties from Wolters Kluwer. A. B. is an employee of Canadian Blood Services. H. K. is an employee of Canadian Blood Services. E. G. C. receives research funding (related to albumin) from Department of Medicine, The Ottawa Hospital and University of Ottawa, The Ottawa Hospital Academic Medical Organization, Kidney Foundation of Canada, and Physician Services Incorporated Foundation; is an editorial board member of the Canadian Journal of Kidney Health and Disease; and is a member of the Contrast-Associated Acute Kidney Injury guideline panel for the Canadian Association of Radiologists. B. R. is a guideline methodologist for American Thoracic Society, the Society of Critical Care Medicine, and Canadian Blood Services; is the Knowledge Translation director for Canadian Critical Care Society; is the grants and manuscripts chair for Canadian Critical Care Trials Group, and in a guideline group member for multiple guidelines. S. R. B. is the chair of the Clinical Pharmacy and Pharmacology section for the Society of Critical Care Medicine (not albumin use related), is a paid consultant for Wolters Kluwer (Lexicomp), is a Society of Critical Care Medicine Social Media Committee member, is a Surviving Sepsis Campaign Research Committee member, and has received a research grant from the National Institute of General Medicine Sciences. L. C. is a guideline group member for the British Society of Gastroenterology (management of ascites in liver cirrhosis), is involved in peer-reviewed publications (multiple topics including relevant to albumin use), received lecturer honoraria for the Canadian Liver Conference 2022, is a hepatology consultant for the Royal Free Hospital London, and is a Liver Committee member of the British Society of Gastroenterology. M. F. receives consultant fees from Cerus Corporation and Biocogniv, Inc.; has received honoraria from Grifols (none were albumin related); is a board member for Project Santa Fe Foundation and the American Board of Pathology; is the Histocompatibility and Identity Testing Committee Chair for College of American Pathologists; is co-team leader for the Biomedical Excellence for Safer Transfusion (BEST)Collaborative; and is the Editorial Committee co-chair for the ICTMG. R. J. has received fellowship funding from Canadian Blood Services, is an employee of William Osler Health System and the University of Cincinnati Medical Center, and is a panel member for ICTMG Platelet Utilization guideline development group. K. P. serves on the board of directors in North America for International Society for Blood Transfusion (ISBT), is a 2023 Association for the Advancement of Blood and Biotherapies (AABB) Red Blood Cells (RBC) guideline panel member, and is a member of the National Advisory Committee of Blood and Blood Products. P. S. S. is director of the Canadian Neonatal Network, director of the Canadian Preterm Birth Network, director of the International Network to Evaluate Outcomes of Neonates, and an external advisory board member for the Canadian Perinatal Surveillance system (none related to albumin manufacturers). H. S. is a consultant for Terumo and Cerus (not albumin related). Z. M. S. is a consultant and advisory board member of Grifols, Fresenius Kabi, and Novartis; receives research funding from Erydel and Fresenius Kabi; serves on the board of directors for the BEST Collaborative and International Council for Commonality in Blood Banking Automation (ICCBBA), Inc.; is the AABB Committee Chair; is vice chair, treasurer, and committee chair for ICCBBA, Inc.; is treasurer for BEST Collaborative; and has a family member (child) who is a summer intern with Grifols, Inc. T. T. is a paid consultant for Inter-View Partners France, A+A, Bayer HealthCare SAS, BVA, Axess Research, and All Global; has received honoraria from AbbeVie, Gilead Sciences, Advanz Pharma France, and Ipsen Pharma; in the principal investigator of randomized controlled trial Albumin Administration in Cirrhotic Patients With Bacterial Infection and a Systemic Inflammatory Response Syndrome Unrelated to Spontaneous Bacterial Peritonitis (ALB-CIRINF) (ClinicalTrials.gov Identifier, NCT01359813) published in 2015; and is a member of the Liver Cirrhosis-related Complications (LCC)-International Special Interest Group. B. W. is a resident physician at Loma Linda University Medical Center. S. S. is chair of the ICTMG and is an employee of National Health Service Blood and Transplant (NHSBT), a blood service operator in England. However, NHSBT is not a manufacturer of the intervention. N. S. is an employee of Canadian Blood Services; receives research funding from the Canadian Institutes for Health Research (Transfusion Requirements in Younger Patients Undergoing Cardiac Surgery [TRICS-IV] RBC transfusion in young cardiac patients; not related to albumin); is an advisory board member for Fresenius Kabius and Janssen; has received honoraria from the International Financial Corporation of the World Bank, Canadian Blood Services, and Ferring; and serves on the PKD guideline panel and ICTMG guideline panels (Fetal Neonatal Alloimmune Thrombocytopenia [FNAIT], Hemolytic Disease of the Newborn [HDN], platelet transfusion, RBC specifications). None declared (D. F., S. A., M. N., C. P., S. R.). See Appendix 8 for the ICTMG Conflict of Interest Policy.

Comment in

Challenges in the use of intravenous albumin in critically ill patients: Reflections and future perspectives.
González-Castro A, Ferrero-Franco R, Blanco Huelga C. González-Castro A, et al. Med Intensiva (Engl Ed). 2024 Jul;48(7):429-430. doi: 10.1016/j.medine.2024.04.016. Epub 2024 May 11. Med Intensiva (Engl Ed). 2024. PMID: 38735809 No abstract available.

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Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines

Collaborators

Affiliations

Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Comment in

References

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