Liver and pancreas
Albumine
The main protein in the blood, made by the liver; low with inflammation, malnutrition, liver or kidney disease.
Everything about this testWhat it measures
Albumin is the most common protein in the blood and is made by the liver. It keeps fluid in the blood vessels and carries hormones, calcium, fatty acids, bilirubin and many medicines. The value falls when the liver makes less (liver disease, malnutrition), when the body loses albumin (via the kidneys or the gut) or when there is inflammation: during illness, the liver temporarily turns down production. Albumin is also used to correct other results, such as calcium and the calculation of free testosterone.
- Reduced protein production by the liver in advanced liver disease (cirrhosis)
- Protein loss via the kidneys (nephrotic syndrome) or via the gut
- Malnutrition and long-term inflammation or illness
- Dehydration (then the value is actually raised)
High
A raised albumin almost always means that the blood is concentrated: dehydration from drinking too little, diarrhea, vomiting, fever or sweating. Keeping the tourniquet on for a long time during the blood draw, or standing just before the sample collection, also gives a slightly higher value. The body does not make an excess of albumin; a high value is therefore not a disease of the liver or kidneys. Symptoms that go with dehydration: thirst, a dry mouth, dark urine, dizziness when standing up.
Low
A low albumin often has a temporary cause: any inflammation or infection lowers production, and the value is also lower in pregnancy, with prolonged bed rest and at an older age. A clearly or persistently low albumin fits malnutrition (eating little, losing a lot of weight, chronic illness), advanced liver disease such as cirrhosis, protein loss via the kidneys (then there is a lot of protein in the urine and fluid builds up in the legs and around the eyes) or via the gut (for example in Crohn's disease or celiac disease). In healthy people without symptoms, a markedly low albumin is unusual and the measurement is repeated.
If your result is abnormal
With a low albumin, the GP first looks at inflammation (CRP), diet and weight and repeats the measurement after recovery from any illness. If the value stays low, testing of the liver (ALAT, bilirubin, clotting) and of the kidneys with a urine test for protein follows, and if needed referral to an internist (specialist in internal medicine) or a dietitian.
Reliability
Albumin is a non-specific value: many different situations lower it, and a low value rarely points to one particular disease. In healthy adults, the result is almost always normal and the test adds little. As a measure of malnutrition, albumin responds slowly and is strongly affected by inflammation; the Dutch Society for Clinical Chemistry (NVKC) describes the test mainly as an aid for hospital patients and for assessing the liver and kidneys.
Limitations
- Any inflammation or infection, even a cold, lowers albumin temporarily; do not have blood drawn during illness.
- Dehydration, keeping the tourniquet on for a long time during the sample collection and standing just before the sample collection raise the value; prolonged lying down lowers it.
- Pregnancy, the contraceptive pill and older age give lower values.
- Measurement methods differ per laboratory; at very low values, results differ noticeably between methods.
How common is this
A low albumin in healthy adults without symptoms is rare. In older people, people with a chronic illness and hospital patients it is common, usually due to malnutrition or inflammation. Severe protein loss via the kidneys (nephrotic syndrome) and liver cirrhosis are rare in general practice.
Who is this useful for
Useful with unintended weight loss or suspected malnutrition, with a known liver or kidney disease to monitor its course, with fluid in the legs without a clear cause, and as a supporting value to properly assess calcium or free testosterone. In healthy adults without symptoms, a stand-alone albumin test adds little.
Downsides and risks
- A slightly low albumin during or shortly after an infection is normal and, without a repeat measurement, can lead to unnecessary worry.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results