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Low Albumin (Hypoalbuminaemia)

Causes

The most common cause of low blood albumin in horses is intestinal disease. If there is diarrhoea then the loss is likely from the large intestine, if there is no diarrhoea then the loss is most likely from the small intestine. The causes of intestinal disease include worms particularly encysted redworm, sand, inflammatory bowel disease, some medications, infection, or neoplasia. It may also be caused by kidney or liver disease in rarer cases.

Symptoms

• Weight loss
• Fluid swelling under belly and/or lower legs
• Lethargy
• Not quite right
• Diarrhoea
• No outward symptoms in mild cases

Diagnosis

The low albumin is shown on a blood test. The cause can be investigated with:

• an ultrasound scan on the abdomen to assess the small intestine, large intestine, kidneys and liver.
• Faecal testing for worm burden, sand and infections.
• Further blood testing looking for concurrent disease or inflammation.
• Biopsy of the small intestine or rectum.
• Gastroscopy.

Treatment

The specific treatment depends on the underlying cause but may include:

• Wormer – encysted red worm is a common cause of low albumin so an equest wormer is usually recommended.
• Steroids – the albumin is leaked through inflamed intestine walls therefore steroids are often indicated to treat the inflammation.
• Misoprostal – a medication which improves the blood supply to the intestine to aid healing.
• Psyllium – if sand is suspected and for large intestine support.
• Probiotic supplement.
• Fluids – if dehydrated.
• Stopping any medications which could be the cause.
• Treating any concurrent disease.
• Plasma transfusion may be required in severely affected horses.

Prognosis

Mild cases which respond well to treatment quickly have a good prognosis, particularly if the underlying cause is identified and treated. However, some cases may require long-term treatment such as inflammatory bowel disease. Severely affected hypoalbuminaemic horses particularly with a heavy encysted redworm burden can have a poor prognosis and the condition may lead to euthanasia.