Transfusion medicine handbook

5. Fractionated Products

5.3.3 ALBUREX 20 NZ (Human albumin 20%)

Alburex 20 NZ contains 200 g/L albumin in solution for intravenous administration and is hyper-oncotic to normal plasma. It is available in vials of 100 mL. The manufacturing process includes pasteurization, ethanol fractionation and filtration to the 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 [2].

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.

The colloid-osmotic effect of human albumin 200 g/L is approximately four times that of blood plasma. Therefore, when concentrated albumin is administered, care must be taken to assure adequate hydration of the patient. Patients should be monitored carefully to guard against circulatory overload and hyperhydration.

200–250 g/L human albumin solutions are relatively low in electrolytes compared to the 40–50 g/L human albumin solutions. When albumin is given, the electrolyte status of the patient should be monitored and appropriate steps taken to restore or maintain the electrolyte balance.

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 20 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 [2].

Administration

Alburex 20 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 20 NZ datasheet says 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 3^rd 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 20 NZ with red cells in contrast to the datasheet, then they need to have appropriate experience and undertake their own risk assessment.