Pregnancy with hypoalbuminemia
Low level of albumin is common in pregnancy Hypoalbuminemia related with many obstetric complications during pregnancy. We should be concerned about its early detection and its correction.
What is albumin?
Albumin is a family of globular protein, the most of which are the serum albumin.
Normal level of albumin: 3.4 to 5.4 g/dl
Low albumin level means patient may have malnutrition, liver disease, or inflammatory disease.
Function of Albumin?
Function: serum albumin is the main protein of human blood plasma. It binds water cations (Ca2+, Na2+, K+), fatty acids, hormones, bilirubin, thyroxinT4 and drugs. Its main function is to regulate the osmotic pressure of blood. Osmotic pressure of blood help to draw fluid from the body into the blood vessels.
What happens when pregnant patient have low albumin level?
Albumin helps keep fluid in our blood stream as it does not leak into the tissues. It also carries various substances throughout our body, including hormones, vitamins and enzymes, low albumin level can indicate a problem with liver or kidney.
Some common symptoms of hypoalbuminemia include:
* Fluid retention that causes swelling especially of the feet or hands
* Weakness, exhaustion
* Rapid heartbeat
* Vomiting, diarrhea and nausea
* Appetite changes
* Abnormal renal and liver function
* Ascites, plural and pericardial effusion
* PE (pre-eclampsia)
* PTL (preterm labour)
* IUGR ( Intrauterine growth restriction)
* Placental insufficiency
* Abruption placentae
* Higher rate of LSCS
Effects on foetus:
* IUGR (Intrauterine growth restriction)
* Higher rate of fetal distress and
* Nm immune hydrops foetal.
Deserving ciosure surveillance during pregnancy
Can pregnancy causes low albumin level? It's important to have normal level of plasma protein during pregnancy. Studies suggest that low levels of pregnancy associated protein (PAPP-A) in early pregnancy are related to certain complications like abortion, IUGR.
Why hypoalbuminemia occur in pregnancy?
Albumin is the fraction that is usually lost during proteinuria in pregnancy .Thus, hypoalbuminemia in pregnancy not necessarily be only due to decrease in production but also due to dilution (due to increased volume) and increase loss in urine (proteinuria). Pregnancy decreases albumin level 1 gm/dl.
What are the investigations should be done in case of hypoalbuminemia?
Clinical suspicion of the underlying disease process should guide appropriate laboratory studies.
It can be treating by addressing the underlying condition or by getting albumin levels back to normal.
* Life style changes : eating more protein rich food (meat, pork, veil, butter and eggs)
* Medications: appropriate treatment of infection or inflammation
* Avoid alcohol
* Effective control of blood pressure if patient is hypertensive.
* Inj. Human albumin: if albumin level is less than 2.5 gm/dl.
Calculation of the dose of albumin to administer
Dose (G) = ( 2.5g/dl- actual albumin concentration ) x (kgx0.8)
2.5 g/dl: desired concentration of albumin; kg: body weight; 0.8: coefficient to calculate the volume of plasma.
Preparations of albumin
Solutions of albumin are prepared from the plasma of healthy donors. The albumin is pasteurize at 60 C or 10 hours 30. It can be infused independently of the recipient's blood group. Preparations of 5%, 20% and 25% have been registered. The solutions of 5% human albumin have an osmotic pressure almost identical to that of normal plasma; the 20% and 25% solutions are hyperosmotic. All the preparations are hyperosmotic. All the preparations contain 130-160 m Eq of sodium per liter.
Pregnancy and lactation:
Pregnancy: it is not known whether albumin products can cause fetal harm or affect reproductive capacity when administered to a pregnant woman. No human or animal date are available to indicate the presence of absence of drug-associated risk with albumin use during pregnancy. It is not known whether albumin is excreted in human milk. No human or animal data are available to indicate the presence or absence of drug -associated risk with albumin use while breast-feeding.
There is a possibility of preventing PE by maintaining adequate blood protein levels during early pregnancy.