Estimation of Albumin

A Case of Cirrhosis of liver

• A 55 Years old patient was admitted to the
hospital complaining of headache and
indigestion for 15-20 days. The patient on
examination showed yellowish
discoloration of sclera. He was a chronic
alcoholic. Ultrasound Abdomen report
showed enlarged liver with portal
hypertension distended GB with sludge,
mild splenomegaly, and mild ascites. The
lab values for LFT were as follows:
• Bilirubin: 17.0 mg/dl,
• Bilirubin direct :13.0 mg/dl,
• ALT(SGPT): 65.0 IU/L,
• AST(SGOT): 190 IU /L,
• Alkaline Phosphatase: 315 IU/L,
• Gamma glutamyl transferase-360 U/L,
• Prothrombin time - 25 sec
 Causes of Cirrhosis
• Chronic alcohol abuse
• Chronic viral hepatitis (hepatitis B, C and D)
• Fat accumulating in the liver (nonalcoholic fatty liver disease)
• Iron buildup in the body (hemochromatosis)
• Cystic fibrosis
• Copper accumulated in the liver (Wilson's disease)
• Poorly formed bile ducts (biliary atresia)
• Alpha-1 antitrypsin deficiency
• Inherited disorders of sugar metabolism (galactosemia or glycogen storage
disease)
• Genetic digestive disorder (Alagille syndrome)
• Liver disease caused by your body's immune system (autoimmune
hepatitis)
• Destruction of the bile ducts (primary biliary cirrhosis)
• Hardening and scarring of the bile ducts (primary sclerosing cholangitis
• Infection, such as syphilis or brucellosis
• Medications, including methotrexate or isoniazid
 Symptoms and signs
• Fatigue
• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in your legs, feet or ankles (edema)
• Weight loss
• Itchy skin
• Yellow discoloration in the skin and eyes (jaundice)
• Fluid accumulation in your abdomen (ascites)
• Spiderlike blood vessels on your skin
• Redness in the palms of the hands
• For women, absent or loss of periods not related to menopause
• For men, loss of sex drive, breast enlargement (gynecomastia) or testicular
atrophy
• Confusion, drowsiness and slurred speech (hepatic encephalopathy)
 Pathophysiology of Alcohol induced
cirrhosis of liver

• Alcohol causes injury to the liver

• Increased release of inflammatory cytokines -
PDGF, TNF alpha, IL-1
• Activates hepatic stellate cells
• Replacement of injured tissue by scar tissue
• Fibrosis of liver
• Blockade of portal blood flow
• Portal hypertension
• Hypersplenism
 Complications
• Portal hypertension
• Swelling in the legs and abdomen(ascites).
• Splenomegaly, decreased white blood cells and
platelets
• esophageal varices,gastric varices
• Infections
• Malnutrition
• Buildup of toxins in the brain (hepatic
encephalopathy).
• Jaundice
• Increased risk of liver cancer
Estimation of Albumin by BCG dye
method
PRINCIPLE
• Albumin in the presence of bromocresol
green at a slightly acid pH, produces a
colour change of the indicator from yellow-
green to green-blue. The intensity of the
color formed is proportional to the albumin
concentration in the sample.
• Wavelength - 600 nm
• Incubation - 10 min
 Procedure
Blank Standard Test

Distilled 2ml - -
water
Standard - 2ml -

Serum - - 2ml
sample
BCG 1ml 1ml 1ml
reagent

Concentration of Standard- 5 gms/dl

Normal range: 3.5 to 5.0 g/dl

Hypoalbuminemia can be caused by various conditions, including nephrotic

syndrome, hepatic cirrhosis, heart failure, and malnutrition