Albumin

Liver

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Measures serum albumin, reflecting liver synthetic function and protein nutritional status.

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Albumin Test - Comprehensive Medical Information Guide

Why is it done?
- What the test measures: The albumin test measures the level of albumin, a major protein produced by the liver that circulates in the blood and plays a crucial role in maintaining blood volume, transporting nutrients and hormones, and regulating osmotic pressure.
- Primary indications for testing: Evaluation of liver function, assessment of nutritional status, investigation of kidney disease, evaluation of malabsorption disorders, assessment of inflammatory conditions, and monitoring of chronic diseases such as diabetes and cirrhosis.
- Typical timing and circumstances: Albumin is often measured as part of routine comprehensive metabolic panels (CMP) during annual physicals, in hospitalized patients, when liver or kidney disease is suspected, during nutritional assessments, in patients with edema or ascites, and when monitoring response to treatment for chronic conditions.
- Clinical context: Albumin represents approximately 50-60% of total serum protein and has a half-life of approximately 20 days, making it a useful marker for assessing long-term nutritional and liver status rather than acute conditions.
Normal Range
- Standard reference range: 3.4 to 5.4 g/dL (grams per deciliter) in adults, though normal ranges may vary slightly between laboratories and testing methodologies.
- Alternative units: 34 to 54 g/L (grams per liter) - equivalent to the g/dL measurement used by many international laboratories.
- Interpretation of normal results: Values within this range indicate adequate liver function, appropriate protein synthesis, and generally good nutritional status. Normal albumin typically suggests the liver is functioning well and that the patient has sufficient protein intake and absorption.
- Low albumin (hypoalbuminemia): Values below 3.4 g/dL are considered low and may indicate liver disease, malnutrition, malabsorption, kidney disease with proteinuria, severe inflammation, or other systemic conditions.
- High albumin (hyperalbuminemia): Values above 5.4 g/dL are rare and typically indicate severe dehydration or hemoconcentration, as true albumin elevation cannot occur due to the liver's fixed capacity for albumin synthesis.
- Age-related considerations: Albumin levels may be slightly lower in elderly individuals (3.2-5.0 g/dL) due to changes in liver function and protein metabolism with aging.
Interpretation
- Severely low albumin (<2.0 g/dL): Indicates significant liver disease (cirrhosis, chronic hepatitis), severe malnutrition, nephrotic syndrome with substantial protein loss, severe malabsorption, severe infection or sepsis, or critical illness. This level often correlates with clinical symptoms such as ascites, edema, and compromised immune function.
- Moderately low albumin (2.0-3.4 g/dL): Suggests chronic liver disease, moderate malnutrition or inadequate protein intake, chronic kidney disease with proteinuria, chronic inflammatory conditions (inflammatory bowel disease, rheumatoid arthritis), malabsorption syndromes, or chronic infections.
- Mildly low albumin (3.4-3.6 g/dL): May indicate early stage liver dysfunction, mild malnutrition, mild chronic disease, or pregnancy-related changes (normal albumin decreases during pregnancy). May also represent normal variation in some individuals.
- Factors affecting albumin levels: Hydration status significantly impacts results (dehydration falsely elevates, overhydration falsely lowers); medications such as corticosteroids may affect levels; pregnancy typically lowers albumin by 20-30%; inflammation and acute illness cause rapid albumin decline; timing of measurement is important as albumin changes over weeks to months, not days.
- Clinical patterns and significance: Progressive decline in serial measurements suggests worsening chronic disease or progressive liver dysfunction; acute drops may indicate acute illness or hospitalization stress; stable low levels in chronic disease patients help establish disease severity; albumin in context of other proteins (globulins) and liver enzymes provides more complete clinical picture.
- Prognostic value: Serum albumin is an independent predictor of morbidity and mortality in various conditions; low albumin is associated with increased risk of infection, poor wound healing, prolonged hospital stays, and adverse surgical outcomes; used in prognostic scoring systems such as Model for End-Stage Liver Disease (MELD) score.
Associated Organs
- Primary organ - Liver: The liver is the sole site of albumin synthesis, producing approximately 12-15 grams per day under normal conditions. Liver disease from any cause (viral hepatitis, alcoholic cirrhosis, non-alcoholic fatty liver disease, autoimmune hepatitis, hemochromatosis) leads to reduced albumin production and low serum levels.
- Kidneys: The kidneys are involved in albumin metabolism and excretion. Glomerular filtration barrier damage leads to albumin loss in urine (proteinuria) and reduced serum levels. Nephrotic syndrome is characterized by massive proteinuria and hypoalbuminemia. Chronic kidney disease causes progressive albumin depletion and nutritional complications.
- Gastrointestinal tract: The digestive system is critical for protein absorption and albumin synthesis substrate provision. Malabsorption diseases (celiac disease, Crohn's disease, short bowel syndrome), inflammatory bowel disease, and gastrointestinal bleeding lead to reduced albumin levels due to decreased protein intake or absorption.
- Immune system and infection: Acute and chronic infections cause albumin reduction through multiple mechanisms including increased catabolism, redistribution to extravascular spaces, and altered synthesis. Sepsis, tuberculosis, and chronic infections are associated with hypoalbuminemia.
- Heart: Cardiac disease and congestive heart failure contribute to hypoalbuminemia through malnutrition, hepatic congestion, and increased catabolism. Severe heart failure with hepatic congestion impairs albumin synthesis.
- Diseases commonly associated with abnormal albumin: Cirrhosis, hepatitis, fatty liver disease, nephrotic syndrome, chronic glomerulonephritis, diabetes mellitus, malnutrition, inflammatory bowel disease, celiac disease, tuberculosis, malignancies, burns, trauma, sepsis, and autoimmune disorders.
- Complications of low albumin: Edema (swelling due to fluid accumulation), ascites (abdominal fluid accumulation), increased infection risk (impaired immune function and wound healing), poor surgical outcomes, increased bleeding tendency, impaired medication transport and efficacy, and worsened prognosis in chronic diseases.
- Systemic manifestations: Prolonged low albumin leads to malnutrition signs (weight loss, hair loss, nail changes), weakness and fatigue, delayed wound healing, increased susceptibility to infections, anemia, and worsening of underlying chronic conditions.
Follow-up Tests
- Liver function tests: If low albumin is found, comprehensive hepatic panel including total bilirubin, direct bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and prothrombin time (PT) should be ordered to assess liver synthetic and metabolic function.
- Kidney function tests: Serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR) to assess kidney function. Urinalysis and 24-hour urine protein to quantify proteinuria if nephrotic syndrome is suspected.
- Total serum protein and protein fractions: Electrophoresis to evaluate the ratio of albumin to globulins and assess for abnormal protein patterns that may indicate myeloma or other conditions. A/G ratio provides additional clinical context.
- Nutritional markers: Prealbumin (transthyretin), total lymphocyte count, transferrin, and anthropometric measurements to comprehensively assess nutritional status and the etiology of hypoalbuminemia.
- Hepatitis serology: Hepatitis A, B, and C antibodies/antigens if viral hepatitis is suspected as a cause of liver dysfunction and low albumin.
- Autoimmune markers: Antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and anti-mitochondrial antibody (AMA) if autoimmune liver disease is suspected.
- Imaging studies: Abdominal ultrasound or CT to evaluate liver structure, assess for cirrhosis, fibrosis, fatty infiltration, or masses. Ultrasound also useful to assess for ascites and evaluate kidney size/structure.
- Advanced liver tests: Fibroscan (transient elastography) or FIB-4 index to assess liver fibrosis severity if cirrhosis is suspected. Model for End-Stage Liver Disease (MELD) score calculation for severity assessment.
- Monitoring frequency: For chronic disease management, albumin should be rechecked every 3-6 months in stable patients with chronic liver disease or malabsorption. More frequent monitoring (weekly to monthly) may be needed in acute illness, hospitalized patients, or those undergoing treatment. Serial measurements help track disease progression or improvement.
- Related complementary tests: Prothrombin time (PT/INR) for synthetic function; albumin-bilirubin (ALBI) score for prognosis; albumin-to-platelet ratio index (APRI) for fibrosis assessment; other acute phase proteins and inflammatory markers.
Fasting Required?
- Fasting requirement: NO - Fasting is not required for the albumin test. The test can be performed at any time of day without dietary restrictions. Albumin levels remain stable regardless of recent food intake.
- Timing considerations: While fasting is not required specifically for albumin measurement, it is often ordered as part of a comprehensive metabolic panel (CMP) for which fasting may be recommended (typically 8-10 hours). Check with your healthcare provider regarding specific instructions if albumin is combined with other tests.
- Hydration status: Maintain normal hydration on the day of testing. Severe dehydration can artificially elevate albumin levels, while overhydration can falsely decrease them. Normal fluid intake before the test is recommended.
- Medications: No specific medications need to be avoided before the albumin test. However, inform your healthcare provider of all medications you are taking, as certain medications may affect albumin levels or interpretation.
- Physical activity: Normal daily activities can be maintained. Strenuous exercise immediately before blood draw is not necessary to restrict specifically for albumin testing.
- Patient preparation: Inform your healthcare provider if you are pregnant, as albumin levels naturally decrease during pregnancy. Report recent blood transfusions or intravenous fluid administration, as these may temporarily affect results.
- Specimen collection: A simple blood draw from a vein in the arm is required. No special collection tube or special handling is needed. The sample is typically processed by automated laboratory analyzers.
- Results timing: Results are typically available within 24-48 hours, often sooner if part of a stat or urgent panel in hospitalized settings.

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