Makindo Medical Notes

HAS is issued by the Trust blood bank. Similar to other plasma products it is produced by the fractionation of donated whole blood. As HAS is a blood product it must be prescribed for a specific patient and is subject to the same scrutiny and reporting mechanisms as other plasma products including traceability. Consent from the patient must be obtained prior to administration. It is important to remember that patient, who refuse blood products, may decline treatment.

About: Always check the BNF link here

• See BNF. It is a colloidal fluid. It is not routinely used to boost albumin levels

Mode of action

• 4.5% solution has 45 g per 1000 ml and has the same oncotic pressure as plasma and its uses are quite different from concentrated hyperoncotic 20% solution.
• 20% solution is more concentrated and has 200 mg Albumin per 1000 ml (1 L)

Indications/Dose

• The 4.5% solution is more dilute may be used as a volume expander or in burns, pancreatitis, trauma, and complications of surgery (with isotonic solutions)
• Paracentesis: 8 g Albumin give for each litre of ascites removed 20% (200 g/L) HAS is given for all large paracentesis. 100 mls of 20% HAS should be given for every 3L of ascites drained. Usually given over at least 2 hours.
• Spontaneous bacterial peritonitis: Day 1 and 2: 1.5g/kg 20% HAS Day 3 onwards: 1g/kg until significant improvement in the patient's clinical condition
• Hepatorenal syndrome: Day 1: 1g/kg 20% HAS. Day 2-14: 0.5g/kg 20% HAS. Stop once condition improved

Not indicated

• Daily infusions of albumin provide no significant health benefit to patients hospitalised with advanced liver cirrhosis, over and above 'standard care'
• Albumin administration is not recommended to correct hypoalbuminemia per se in liver disease

Interactions

• See BNF

Cautions

• Fluid overload and inducing heart failure
• Usually issued from blood bank on named patient basis.
• 20% albumin is hyperoncotic and can expand causing fluid overload e.g. pulmonary oedema

Contraindications

• See BNF

Side effects

• Circulatory overload, Infusion/allergic reactions
• Theoretical risk of transmission of nvCJD

References

• Human albumin in the management of complications of liver cirrhosis
• Guideline for the use of human albumin solution (HAS)

References