Presentation
- There are currently two products available at the moment - Albumex and Alburex. Albumex is being phased out and replaced by Alburex as the manufacturerer has changed its manufacturing technique. Please see the letters sent about this:
- Albumin is provided in two strengths
- Physiological concentration (4-5%). This is used for volume expansion, cardiac bypass and plasma exchange.
- Albumex 4 bottles are 500 mL (20g). (50mL bottles have been discontinued - Please read here for more information)
- Alburex 5 bottles are 500 mL (25g). This will become available in late 2024.
- Hyperoncotic concentration (20%), sometimes also known by the older name of salt-poor albumin. It is used to replace albumen in hypoproteinaemic patients (eg burns, sepsis, ascites).
- Albumex 20 is supplied as bottles of either 10mL (2g) or 100mL (20g).
- Alburex 20 is supplied as bottles of only 100mL (20g).
ABO Compatibility
- Compatibility is not relevant for manufactured (fractionated) plasma product transfusion
- Hypotension has been reported in patients who are also on ACE inhibitors
Storage and Infusion
- May be stored at room temperature but a blood or vaccine fridge is preferred. Do not freeze. 10mL Albumex® 20 vials must be stored at 2-8°C
- It is preferable to allow the bottle to come to room temperature before infusing.
- Use a vented infusion set or a standard (or blood) infusion set with a venting spike (open IV system). No filters are needed.
- Ensure the bottle is designated for the patient being transfused.
- If using from an emergency stock, ensure Blood Bank are informed of the patient and batch numbers transfused
Precautions
- Read manufacturer's instructions carefully
- Always observe for turbidity, floating material and sediment
- Pumps acceptable for use.
Rate
- Complete the infusion within 4 hours of spiking the bottle.
- Monitor rate/volume closely
- For volume expansion/resuscitation, Albumex 4 and Alburex 5 may be administered as a rapid infusion to restore perfusion / blood pressure.
- As 20% albumin solutions (Albumex 20 and Alburex 20) are hyperoncotic, they increase volume by four times by drawing fluid from the extravascular spaces into the vascular system. Administer slowly and carefully. Monitor for signs of volume overload.
- See under Dose for rates for some specific indications.
Monitoring
- It is recommended that blood pressure is monitored regularly during administration.
- Myocardial function should also be monitored e.g. central venous pressure, arterial pressure and pulse rate.
- To avoid circulatory overload the rate and volume of infusion should be monitored frequently.
- Hypokalaemia, thrombocytopenia and prolonged prothrombin times may be worsened with Albumex infusions and should also be monitored.
- Recipients should remain under observation for 20 minutes following administration.
DO NOT
- DO NOT add medications to blood products.
- Alburex 5 or 20 must not be mixed with any other medicinal products, including whole blood, packed red cells, or other albumins.
Dose
(adult)
- Resuscitation: In an average adult, hypovolaemic shock usually requires at least 1L physiologic albumin (Albumex 4 or Alburex 5). The total volume required cannot be accurately predicted, since it depends on a number of factors. NB: Monitor infusion and patient (eg BP, pulse and CVP, if available) carefully to avoid circulatory overload.
- The acutely ill with hypoproteinaemia: The usual adult daily dose is 250-375mL 20% albumin (Albumex 20 or Alburex 20 (equivalent to 50-75g albumin). The rate of administration should not exceed 2 mL/min. More rapid infusion may precipitate circulatory overload and pulmonary oedema. NB: Albumex 20 and Alburex 20 are hyperoncotic. Monitor infusion and patient (eg CVP, BP, pulse) carefully to avoid circulatory overload.
- Burns: The usual adult dose is 20-80g Albumex 20 or Alburex 20 given daily at the rate of about 1mL/min.
- Adult respiratory distress: Commence with a dose of 250ml Albumex 20 or Alburex 20 (equivalent to 50g albumin) over the first 24 hours together with diuretic therapy. Thereafter adjust dose according to vital signs and plasma albumin concentration.
- Haemodialysis: Adults with significant fluid overload may benefit from the administration of 100-200mL of Albumex 20 or Alburex 20 at the end of the dialysis procedure.
- Paracentesis: infuse 8g of Albumex 20 or Alburex 20 per liter of ascites removed after completing a paracentesis of more than 5 litres.
Dose
(paediatric)
- Resuscitation: In children, hypovolaemic shock the recommended dose is 10-20mL/kg Albumex 4 or Alburex 5. The total volume required cannot be accurately predicted, since it depends on a number of factors. NB: Monitor infusion and patient (eg CVP, BP, pulse) carefully to avoid circulatory overload.
- Alcutely ill with hypoproteinaemia: In children the recommended dose is 2.5-5mL/kg Albumex 20 or Alburex 20 (equivalent to 0.5-1g/kg albumin), administered over 2-3 hours. More rapid infusion may precipitate circulatory overload and pulmonary oedema. NB: Albumex 20 and Alburex 20 are hyperoncotic. Monitor infusion and patient (eg CVP, BP, pulse) carefully to avoid circulatory overload.
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