Must knows in Human Serum Albumin Transfusion

Nurse Giselle re-reads the order in the chart. The attending physician has just conducted his rounds and ordered for human albumin transfusion for the patient. Yes, she has seen others do it. She has experienced witnessing her colleagues perform albumin transfusions to their patients, she even assisted in some, but she hasn’t actually done it on her own.

“What do I do? What do I need?”

Her brows furrow as she worries on what she needs to remember when performing such.

“I can do this,” she tells herself and reads the order one more time.

Human Albumin Transfusion: An overview

Albumin plays an important role in health and disease. Albumin is a major contributor to colloid oncotic pressure (COP), binds endogenous and exogenous molecules, mediates coagulation, and helps to maintain normal microvascular permeability. Significant hypoalbuminemia contributes to increased morbidity and mortality. Albumin can be administered via the transfusion of plasma products, or via the infusion of human serum albumin (HSA).

Human serum albumin or HAS, is manufactured from pooled human plasma that is ultrafiltrated and heat sterilized. It has a prolonged shelf-life without refrigeration. Hyperoncotic 25% HSA contains 0.25g albumin/ml (10 times that of plasma) and has a COP of 200 mmHg. (wherein the COP of normal canine plasma is 20 mmHg, and that of 6% hetastarch 30-45 mmHg., which is the reason why it would appear an ideal solution for the management of patients with severe hypoalbuminemia.

Albumin usually has a clear to pale yellow color but may occasionally have a green discoloration, which may be due to small amounts of biliverdin, which is a green-colored breakdown product of hemoglobin and is carried by albumin in human plasma.

Indications and Usage for Albumin (Human)

  • Hypovolemia
  • Hypoalbuminemia
  • Prevention of Central Volume Depletion after Paracentesis due to Cirrhotic Ascites (Treatment Adjunct)
  • Ovarian Hyperstimulation Syndrome (OHSS)
  • Adult Respiratory Distress Syndrome (ARDS) (Treatment Adjunct)
  • Acute Nephrosis (Treatment Adjunct)
  • Hemolytic Disease of the Newborn (HDN)

Cautions

When giving human albumin transfusions, certain things must be taken into consideration, such as:

  1. Prior to administration, parenteral drug products should be inspected visually for turbidity and discoloration.
  2. The healthcare provider must remember not to dilute with sterile water for injection.
  3. Solutions of Albumin (Human) 20% which are cloudy or have deposits, must not be used and once the infusion container has been opened the contents should be used immediately.
  4. The unused portion must also be discarded.
  5. Filtration of Albumin (Human) 20% is not required.
  6. The infusion rate should be adjusted according to the individual circumstances and the indication. In plasma exchange during paracentesis, the infusion rate may be higher and should be adjusted to the rate of removal.
  7. If large volumes (greater than 1500 ml) are administered, the product should be warmed to room temperature before use.
  8. Since albumin is available in two concentrations, the healthcare provider must ensure that he/she administers the correct concentration since error could result in severe circulatory overload or sudden cardiac failure.
  9. Albumin (Human) 25% solution is made from human plasma and those products made from human plasma may contain infectious agents. The risk that such products will transmit an infectious agent has been extremely reduced by measure such as: screening plasma donors for prior exposure to certain viruses, testing for the presence of certain current virus infections, and inactivating and/or removing certain viruses through alcohol fractionation and through heat treatment of the product in the final container for 10 hours at 60°C. However, despite of all those, such products can still potentially transmit disease.

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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