Transfusion medicine
Transfusion medicine handbook
The Transfusion Medicine Handbook is designed to assist hospital staff and other health professionals in modern Transfusion Medicine Practice.
5. Fractionated Products
5.3.1 ALBUREX® 5 NZ (Human albumin 5%)
Alburex 5 NZ contains 50 g/L albumin in solution for intravenous injection and is mildly hypo-oncotic to normal plasma. It is available in vials of 500 mL. When infused into adequately hydrated patients its effect is to expand the circulating blood volume by an amount approximately equal to the volume of Alburex 5 NZ infused. The manufacturing process includes pasteurization, ethanol fractionation and filtration to reduce pathogens, should they be present. The current procedures are effective against enveloped viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and the non-enveloped virus, hepatitis A virus (HAV) and human parvovirus B19 [1].
Indications for Use
Restoration and maintenance of circulating blood volume where volume deficiency has been demonstrated and use of a colloid is appropriate.
The choice of albumin rather than artificial colloid will depend on the clinical situation of the individual patient.
Precautions
Suspicion of allergic or anaphylactic type reactions requires immediate discontinuation of the infusion. In case of shock, standard medical treatment for shock should be implemented.
Albumin should be used with caution in conditions where hypervolaemia and its consequences or haemodilution could represent a special risk for the patient. Examples of such conditions are:
- decompensated cardiac insufficiency
- hypertension
- oesophageal varices
- pulmonary oedema
- haemorrhagic diathesis
- severe anaemia
- renal and post-renal anuria.
When albumin is given, the electrolyte status of the patient should be monitored and appropriate steps taken to restore or maintain the electrolyte balance.
If comparatively large volumes are to be replaced, controls of coagulation and haematocrit are necessary. Care must be taken to ensure adequate substitution of other blood constituents (coagulation factors, electrolytes, platelets and erythrocytes).
Hypervolaemia may occur if the dosage and infusion rate are not adjusted to the patient’s circulatory situation. At the first clinical signs of cardiovascular overload (headache, dyspnoea, jugular vein congestion), or increased blood pressure, raised venous pressure and pulmonary oedema, the infusion is to be stopped immediately.
Alburex 5 NZ contains approximately 3.2 mg sodium per mL of solution (140 mmol/L). This should be noted when the product is used in patients requiring sodium restriction [1].
Administration
Alburex 5 NZ supplied in a glass vial (bottle) and requires a vented infusion set to administer. The solution contains no antimicrobial preservatives; each bottle must be transfused within 4-hours of spiking (breaking the product seal with the IV set spike).
Incompatibilities
The Alburex 5 NZ datasheet advises it must not be mixed with any other medicinal products, including whole blood, packed red cells, or other albumins.
However, in a minor revision to its 3rd edition of GUIDELINES FOR THE ADMINISTRATION OF BLOOD PRODUCTS, the Australian & New Zealand Society of Blood Transfusion (ANZSBT) suggests that red cells are compatible with albumin. The rationale given for the change is: “To improve guidance where there may be conflicts between prescribing information for medications, prescribing information and well established, often evidence based clinical practice” (Section “Summary of changes”, p 4). If users choose to mix Alburex 5 NZ with red cells in contrast to the datasheet advice, then they need to have appropriate experience and undertake their own risk assessment.