Chapter 3- Albumin Flashcards
What is the molecular weight of serum albumin?
Approximately 67 kilodaltons. One gram of albumin attracts 18 ml of water
Alb made by liver (approximately 16 g per day)
Albumin is the most abundant protein in plasma. Serum albumin is negatively charged but can bind to both cations and anions.
How much does an infusion of 25 grams of albumin expand plasma volume?
It expands plasma volume by 450 ml.
Plasma oncotic pressure helps maintain appropriate levels of water in the circulatory system.
Product specification:
* How is prepared
* Storage
* Available vials
* Expiry
- Prepared from donated plasma by fractionation, viral inactivation by : cold ethanol fractionation, and heat inactivation.
- Storage: 2-30C
- Albumin is available in 2 concentrations: 5% and 25%
- The shelf life ranges from two to five depending on manufacturer
- Viral inactivation occur during fractionation (US)
What are the indications different % of albumin:
o 5% is isosmotic with plasma
- Used for therapeutic plasmapheresis or conditions associated with only volume deficit
- o 25% albumin is hyperonoctic and equivalent to plasma volume 4-5x higher than the infused volume. Used if patient has oncotic deficit.
What are 2 albumins based products available:
o Former is purer. PPF is only available in 5%.
1- Human albumin (Two brands at the CBS: Plasbumin (5% and 25%)
o Alburex (5% and 25%)
2- Purified protein fraction (PPF or plasmanate (Grifols))
What were the key findings of the 2004 SAFE trial?
It is performed on about 7000 IVCU patients. The SAFE trial showed no difference in mortality between 4% albumin and saline for fluid resuscitation. There were also no significant differences in ICU days, hospital days, ventilator days, or multi-organ failure. Subgroup analyses did not show a benefit of albumin infusion in hypoalbuminemic patients.
What are side effects specific to albumin?
A very rare risk of anaphylaxis.
- Anaphylaxis – rare.
- Circulatory overload
- Hypotension – rare case reports of transient
- hypotension in patients on angiotensinconverting enzyme inhibitors.248
- There are no reports of HIV, HCV, CJD or other
- viruses transmitted through albumin
in burn: Intravenous albumin should only be commenced after transfer to
- Consider dose reduction or administering over 3 days if patient at risk for transfusion-associated circulatory overload.
Indications of 25% albumin preparation
- Patients with liver disease and bacterial peritonitis
- Large volume (>5 litre) paracentesis in cirrhotic patients
- Hepatorenal syndrome type 1
Indications of 5% albumin preparations
- Therapeutic plasma exchange
- Thermal injury involving >50% total body surface area, if unresponsive to crystalloid.
Which common senarios in which there are no strong evidence to support the use of albumin?
- Cardiac surgery
- Volume resuscitation for hypovolemia
- Cerebral ischemia / hypovolemic brain injury
- Hypoalbuminemia
- Hypotension during dialysis therapy
- Acute Lung injury: Patients randomized to albumin had higher
rates of bleeding, re-sternotomy, and infections
Malignant ascites – there is no evidence to support the use of albumin in patients
with malignant ascites post-paracentesis.
What are the contraindications of Albumin?
- Patients who would not tolerate a rapid increase in circulating blood volume
- Patients with a history of an allergic reaction to albumin
Plasma volume-expanding therapeutic agent ?
and Alternatives to albumin?
Plasma volume-expanding therapeutic agent:
* crystalloid (The most common is saline, PlasmaLyte and Ringer’s lactate. )
* colloid (e.g. albumin)
* hypertonic solutions (as alternatives to 25% albumin).
Crystalloid therapy versus colloid therapy
* advantages
* disadvantages
advantages: decreased expense, increased urine output and a simpler chemical structure that is easily metabolized and excreted.
**disadvantages: ** are primarily seen in situations requiring large volumes for clinical resuscitation, which may lead to peripheral and pulmonary edema, and a potential for hyperchloremia in patients with renal dysfunction.
Examples of colloid?
- Dextrans (D40, D70)
- Gelatins (haemaccel)
- Hydroxyethyl starches (HESs) (Volulyte®, Voluven® and Hextend)
- and albumin
*Available in Canada
Advantages of colloid therapy versus crystalloid therapy
advantages: Colloids differ from crystalloids in that they have an increased ability to hold water in the intravascular compartment. If there is normal membrane permeability, colloids do not enter interstitial or intracellular compartments and may preferentially increase plasma volume.
disadvantages:
Provide the the dose of albumin 25% in the following conditions:
1- in Large volume paracentesis > 5 litres in cirrhotic patients:
2- Spontaneous bacterial peritonitis (non-malignant)
3- Hepatorenal syndrome type 1 (acute onset)
1-Paracenthese: 6-8 g of albumin per litre of fluid removed
2- SBP: Day 1: 1.5 g/kg
Day 3: 1 g/kg
3-Hepatorenal syndrome type 1: Day 1: 1 g/kg
Days 2–14: 100–200 ml/day
Use of albumin alone is ineffective
