2.2 Low blood volume
BLOOD AND RELATED PRODUCTS›PLASMA
PRODUCTS
Albumin solution
(Human Albumin Solution)
lINDICATIONS AND DOSE
Acute or sub-acute loss of plasma volume e.g. in burns,
pancreatitis, trauma, and complications of surgery (with
isotonic solutions)|Plasma exchange (with isotonic
solutions)|Severe hypoalbuminaemia associated with
low plasma volume and generalised oedema where salt
and water restriction with plasma volume expansion are
required (with concentrated solutions 20 %)|
Paracentesis of large volume ascites associated with
portal hypertension (with concentrated solutions 20 %)
▶BY INTRAVENOUS INFUSION
▶Child:(consult product literature)
Adjunct in the treatment of hyperbilirubinaemia by
exchange transfusion in the newborn (with concentrated
solutions 20 %)
▶BY INTRAVENOUS INFUSION
▶Child:(consult product literature)lCONTRA-INDICATIONSCardiac failure.severe anaemia
lCAUTIONSCorrect dehydration when administering
concentrated solution.history of cardiac disease
(administer slowly to avoid rapid rise in blood pressure and
cardiac failure, and monitor cardiovascular and respiratory
function).history of circulatory disease (administer slowly
to avoid rapid rise in blood pressure and cardiac failure,
and monitor cardiovascular and respiratory function).
increased capillary permeability
lSIDE-EFFECTS
▶Rare or very rareFever.flushing.nausea.shock.urticaria
lMONITORING REQUIREMENTSPlasma and plasma
substitutes are often used in very ill patients whose
condition is unstable. Therefore, close monitoring is
required andfluid and electrolyte therapy should be
adjusted according to the patient’s condition at all times.
lPRESCRIBING AND DISPENSING INFORMATIONA solution
containing protein derived from plasma, serum, or normal
placentas; at least 95 % of the protein is albumin. The
solution may be isotonic (containing 3. 5 – 5 % protein) or
concentrated (containing 15 – 25 % protein).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Infusion
▶Flexbumin(Baxalta UK Ltd)
Albumin solution human 200 gram per 1 litreFlexbumin 20 %
infusion 100 ml bags| 1 bagPs
Flexbumin 20 % infusion 50 ml bags| 1 bagPs
Solution for infusion
▶Albunorm(Octapharma Ltd)
Albumin solution human 50 mg per 1 mlAlbunorm 5 % solution for
infusion 250 ml bottles| 1 bottleP£ 30. 00
Albunorm 5 % solution for infusion 100 ml bottles| 1 bottleP
£ 12. 00
Albunorm 5 % solution for infusion 500 ml bottles| 1 bottleP
£ 60. 00
Albumin solution human 200 mg per 1 mlAlbunorm 20 % solution
for infusion 100 ml bottles| 1 bottleP£ 48. 00
▶Alburex(CSL Behring UK Ltd)
Albumin solution human 50 mg per 1 mlAlburex 5 % solution for
infusion 500 ml vials| 1 vialP£ 50. 00
Albumin solution human 200 mg per 1 mlAlburex 20 % solution
for infusion 100 ml vials| 1 vialP£ 40. 00
▶Biotest(Biotest (UK) Ltd)
Albumin solution human 50 mg per 1 mlHuman Albumin Biotest
5 % solution for infusion 250 ml vials| 1 vialPs
Albumin solution human 200 mg per 1 mlHuman Albumin Biotest
20 % solution for infusion 50 ml vials| 1 vialPs
Human Albumin Biotest 20 % solution for infusion 100 ml vials|
1 vialPs
▶Grifols(Grifols UK Ltd)
Albumin solution human 50 mg per 1 mlHuman albumin Grifols
5 % solution for infusion 500 ml bottles| 1 bottleP£ 49. 50
Human albumin Grifols 5 % solution for infusion 250 ml bottles|
1 bottleP£ 24. 75
Human albumin Grifols 5 % solution for infusion 100 ml bottles|
1 bottleP£ 9. 90
▶Zenalb(Bio Products Laboratory Ltd)
Albumin solution human 45 mg per 1 mlZenalb 4. 5 % solution for
infusion 250 ml bottles| 1 bottleP£ 27. 51
Zenalb 4. 5 % solution for infusion 500 ml bottles| 1 bottleP
£ 55. 02
Albumin solution human 200 mg per 1 mlZenalb 20 % solution for
infusion 100 ml bottles| 1 bottleP£ 54. 00
Zenalb 20 % solution for infusion 50 ml bottles| 1 bottleP£ 27. 00PLASMA SUBSTITUTES
Gelatin
lINDICATIONS AND DOSE
Low blood volume in hypovolaemic shock, burns and
cardiopulmonary bypass
▶BY INTRAVENOUS INFUSION
▶Child:Initially 10 – 20 mL/kilogram, use 3. 5 – 4 %
solutionlCAUTIONSCardiac disease.severe liver disease
CAUTIONS, FURTHER INFORMATIONThe use of plasma
substitutes in children requires specialist supervision due
to the risk offluid overload; use is best restricted to an
intensive care setting.
lSIDE-EFFECTS
▶Rare or very rareChills.dyspnoea.fever.hyperhidrosis.
hypersensitivity.hypertension.hypotension.hypoxia.
tachycardia.tremor.urticaria.wheezing
lPREGNANCYManufacturer ofGeloplasma®advises avoid
at the end of pregnancy.
lHEPATIC IMPAIRMENTUse with caution in severe
impairment.
lRENAL IMPAIRMENTUse with caution in renal impairment.
lMONITORING REQUIREMENTS
▶Urine output should be monitored. Care should be taken to
avoid haematocrit concentration from falling below
25 – 30 % and the patient should be monitored for
hypersensitivity reactions.
▶Plasma and plasma substitutes are often used in very ill
patients whose condition is unstable. Therefore, close
monitoring is required andfluid and electrolyte therapy
should be adjusted according to the patient’s condition at
all times.
lPRESCRIBING AND DISPENSING INFORMATIONThe gelatin
is partially degraded.
Gelaspan®contains succinylated gelatin (modifiedfluid
gelatin, average molecular weight26 500) 40 g, Na+
151 mmol, K+ 4 mmol, Mg^2 + 1 mmol, Cl- 103 mmol, Ca^2 +
1 mmol, acetate 24 mmol/litre;Gelofusine®contains
succinylated gelatin (modifiedfluid gelatin, average
molecular weight30 000) 40 g( 4 %), Na+ 154 mmol, Cl-
124 mmol/litre;Geloplasma®contains partially hydrolysed
and succinylated gelatin (modified liquid gelatin) (as
anhydrous gelatin) 30 g( 3 %), Na+ 150 mmol, K+ 5 mmol,
Mg^2 + 1. 5 mmol, Cl- 100 mmol, lactate 30 mmol/litre;
Isoplex®contains succinylated gelatin (modifiedfluid
gelatin, average molecular weight30 000) 40 g( 4 %), Na+
145 mmol, K+ 4 mmol, Mg^2 + 0. 9 mmol, Cl- 105 mmol,BNFC 2018 – 2019 Low blood volume 595
Blood and nutrition9