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The right transfusion, always, everywhere.
Intravenous albumin for pediatric and adult patients
Why did ICTMG develop a guideline for Albumin?
Intravenous albumin is administered in a wide spectrum of clinical scenarios where serum albumin levels have been reduced by acute or chronic illnesses and/or where crystalloids are deemed ineffective. There are potential benefits and risks associated with the use of intravenous albumin. Very few indications have an evidence base that supports its routine use in clinical practice.
This guideline provides evidence based recommendations for the appropriate use of albumin in specific patient populations where it is commonly prescribed. The recommendations apply to pediatric and adult patients undergoing cardiovascular surgery, kidney replacement therapy, treatment for complications of cirrhosis, or receiving support for critical illness (e.g., intensive care support, sepsis).
How to access the ICTMG publication
ICTMG's publications on albumin use include a clinical practice guideline and a systematic review of its use in cardiac and vascular surgeries.
PROSPERO registration:
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Callum J, Shehata N, Landry D, Skubas N. The use of intravenous albumin in critically ill patients, patients with liver cirrhosis or dialysis dependent patients: a systematic review. PROSPERO: International prospective register of systematic reviews. 2019 CRD42019145152
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Shehata N, Skubas N, Callum J. In patients undergoing cardiothoracic surgery does the use of intravenous albumin compared to no intravenous albumin, crystalloids colloid, gelatin, or hydroxyethyl starch reduce mortality, multisystem organ failure, renal failure, need or duration of renal replacement therapy or mechanical ventilation, or length of stay in the ICU or hospital? PROSPERO: International prospective register of systematic reviews 2020 CRD42020171876
Systematic review
Guideline:
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Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N, on behalf of the ICTMG Intravenous Albumin Guideline Group, Use of Intravenous Albumin: A Guideline from the International Collaboration for Transfusion Medicine Guidelines., CHEST (2024), doi: 10.1016/j.chest.2024.02.049
Additional resources
A knowledge mobilization project (2024-2025) is developing additional resources to support dissemination and implementation of this guideline’s recommendations. Resources will be shared here as they become available.
View a webcast to learn more about the ICTMG guideline on use of intravenous albumin and review the existing evidence used to develop the recommendations. This webcast was recorded through a partnership with ISBT as part of the ICTMG’s knowledge mobilization project. The target audience for this 60-minute webcast includes anyone who performs, manages or studies transfusion medicine.
Journal Club objectives:
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To review appraisal of existing evidence used to derive the ICTMG’s 2024 guideline on the use of intravenous albumin.
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To review the guideline’s recommendations for the appropriate use of intravenous albumin.
Presenters:
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Dr. Sheharyar Raza (speaker)
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Dr. Jeannie Callum (moderator)
Listen to an episode of the Critical Matters podcast as Dr. Jeannie Callum and host, Dr. Sergio Zanotti of Sound Physicians, discuss the use of intravenous albumin in critical care. This approximately 50-minute podcast conversation from September 30, 2024, is available free on Soundcloud, Spotify and Apple Podcasts.
Webinar recording & Mythbusters resource
View the recording from Canadian Blood Services' Breakthroughs in blood: Advancements into action webinar series hosted by Dr. Jeannie Callum, including a presentation and international panel discussion. Download additional resources and tools developed to support practice change, including a Mythbusters slide deck and .PDF which address common myths about intravenous albumin and encourage evidence-based decisions regarding its use.
Webinar objectives:
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Review albumin physiology and the albumin products available.
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Discuss risks of albumin transfusions.
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Review methodology used by ICTMG’s guideline development group for this guideline.
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Discuss the evidence and recommendations for appropriate albumin use in settings where it is commonly prescribed (cirrhosis, critical care, kidney failure, cardiovascular surgery).
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Learn from the panel experts about how they are working to improve the evidence-base for albumin and their efforts to de-prescribe albumin at their organizations.
Presenters/panelists:
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Dr. Sheharyar Raza (speaker)
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Dr. Jeannie Callum (moderator)
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Dr. Edward (Ted) Clark (panelist)
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Dr. Bram Rochwerg (panelist)
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Dr. Alexander Vlaar (panelist)
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Dr. James Daly (panelist)
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Dr. Simon Stanworth (panelist)
International reach
Check out how this guideline is being shared, endorsed, and/or implemented by ICTMG's members and partner organizations internationally.
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July 2024: Use of albumin in critically ill patients, a CHEST Physician Critical Care Commentary published by Drs. Nicole Relke, Mark Hewitt, Bram Rochwerg and Jeannie Callum, discusses considerations around the use of albumin for intensivists.
“Overall, intravenous albumin prescription in critical care patients requires a personalized approach informed by current best evidence and is not without potential harm.”
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December 2024: The International Society for Blood Transfusion (ISBT) has endorsed the ICTMG's use of intravenous albumin guideline.
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January 2025: The Società Italiana di Medicina Interna (SIMI) has endorsed the ICTMG's use of intravenous albumin guideline.
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February 2025: The National Advisory Committee (NAC) on Blood Products (Canada) endorsed the ICTMG Use of Albumin guideline. Read the NAC statement here.
