Biomarker · Liver

Albumin

Also known as: serum albumin, plasma albumin

The most abundant protein in blood, made by the liver. It keeps fluid inside the vessels and carries hormones, drugs, calcium and bilirubin. A low level is common in serious illness and reflects inflammation, loss or poor liver synthesis rather than any one disease.

Open in the 3D explorerLiver anatomy
3D model of the Liver in the Anatomy Nexus anatomy atlas
Interactive 3D model: Liver. Orbit, zoom and click the structures.Load the 3D model
Also known as
serum albumin, plasma albumin
Units
g/L (UK) or g/dL (US)
Measured by
Liver function tests, Urine protein, Kidney function tests

What it is and what it does

Albumin holds water in the circulation by osmotic pull; when it falls, fluid leaks into tissues and causes oedema and ascites. The liver makes about 10 to 15 grams a day and the protein lasts about three weeks in the circulation, so albumin is a slow measure of synthetic function and falls late in liver disease. Far more often a low albumin reflects the acute-phase response (the liver switches to making inflammatory proteins such as CRP during infection, surgery or cancer), losses through the kidney (nephrotic syndrome) or gut, malnutrition, or dilution by intravenous fluids. Because many drugs and about half of blood calcium ride on albumin, laboratories report a calcium value adjusted for it.

Why it may be higher

  • Dehydration (concentration of the blood) is the only common cause of a genuinely high value

Why it may be lower

  • Acute and chronic inflammation, infection, sepsis, surgery, cancer
  • Cirrhosis and other severe liver disease
  • Nephrotic syndrome (loss in urine), protein-losing enteropathy, burns
  • Malnutrition and malabsorption
  • Heart failure, pregnancy, intravenous fluid dilution, older age

A high or low value can be associated with several different situations. The result is interpreted with other results, symptoms, history and clinical findings.

What can affect the result

  • Posture (lying down lowers it slightly), tourniquet time and hydration
  • Acute illness at the time of sampling
  • Pregnancy
Reference ranges. Reference intervals for this marker depend on the laboratory, the assay, the units, age, sex and pregnancy. Interpret a result against the interval printed on the laboratory report, not against a figure from the internet.
Educational content. A biomarker page explains what a substance is and why its level can change. It cannot determine the cause of your result: interpret a result using the range supplied by the laboratory that performed the test, with the clinician who ordered it.