FRI-112-Prediction of treatment failures in a multicentre feasibility trial using human albumin solution to prevent infection in acute decompensation of liver cirrhosis

Введение. Терапевтическое использование раствора человеческого альбумина у пациентов в периоперационном периоде трансплантации печени (ТП) представляет интерес в контексте осложнений и исходов операции. Цель исследования: оценить влияние интраоперационной трансфузии 25% раствора человеческого альбумина на течение раннего послеоперационного периода при ортотопической ТП от посмертного донора. Материалы и методы. В исследование включены 47 пациентов, которым была выполнена трупная ТП. Были сформированы 2 группы: пациенты группы 1 (n = 21) получали трансфузию 25% раствора человеческого альбумина в конце операции ТП и через 24 ч после операции; пациенты группы 2 (n = 26) получали трансфузию 25% раствора человеческого альбумина в первые сутки послеоперационного периода. Осуществляли контроль лабораторных параметров крови пациента перед началом оперативного вмешательства, через 24 ч и через 48 ч после операции. Интраоперационно оценивали значения систолического (САД) и диастолического (ДАД) артериального давления, частоту сердечных сокращений (ЧСС), дозу вазопрессоров, объем инфузионно-трансфузионной терапии, кровопотерю и диурез. В послеоперационном периоде фиксировали возможные осложнения, проведенные сеансы заместительной почечной терапии (ЗПТ), а также количество дней в стационаре. Результаты. Оценка значений САД, ДАД и ЧСС в начале и конце операции показала достоверно лучшие показатели гемодинамики и снижение дозировок вазопрессорной поддержки в конце вмешательства в группе 1 по сравнению с группой 2 (p < 0,05). В послеоперационном периоде инфекционные осложнения зарегистрированы у одного пациента группы 1 и у трех пациентов группы 2. Проведение ЗПТ потребовалось двум пациентам из группы 2. Все пациенты обеих групп были выписаны из стационара, при этом число дней госпитализации в группе 2 было статистически значимо больше по сравнению с пациентами группы 1: 26,9 ± 3,9 против 17,2 ± 4,3 (p < 0,05). Заключение. Интраоперационная инфузия 25% раствора альбумина позволяет стабилизировать показатели гемодинамики в конце операции ТП, снизить потребность в кардиотонической поддержке и сократить время госпитализации у пациентов после ТП. Background. The therapeutic use of human albumin solution in patients in the perioperative period of liver transplantation (LT) is of interest in the context of complications and outcomes of surgery. Objectives: to assess the effect of intraoperative transfusion of 25% human albumin solution on the early postoperative period in orthotopic LT from a postmortem donor. Patients/Methods. The study included 47 patients who underwent cadaveric LT. Two groups were formed: patients in group 1 (n = 21) received transfusion of 25% human albumin solution at the end of LT and 24 hours after surgery; patients in group 2 (n = 26) received transfusion of 25% human albumin solution on the first day of the postoperative period. The laboratory parameters of the patient’s blood were monitored before surgery, 24 hours later, and 48 hours after surgery. Intraoperatively, the values of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), dose of vasopressors, volume of infusion- transfusion therapy, blood loss and diuresis were assessed. In the postoperative period, possible complications, renal replacement therapy (RRT) sessions performed, and the number of days in the hospital were recorded. Results. Assessment of SBP, DBP and HR values showed significantly better hemodynamic parameters and reduced dosages of vasopressor support at the end of surgery in group 1 compared to group 2 (p < 0.05). In the postoperative period, infectious complications were registered in one patient of group 1 and in three patients of group 2. Two patients from group 2 required RRT. All patients were discharged from the hospital, while the number of hospitalization days in group 2 was statistically significantly greater than in patients in group 1: 26.9 ± 3.9 versus 17.2 ± 4.3 (p < 0.05). Conclusions. Intraoperative infusion of 25% albumin solution allows stabilizing hemodynamic parameters at the end of LT surgery, reducing the need for cardiotonic support and shortening the hospitalization time in patients after LT.

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Brief Report: Hemoglobin-Coated Charcoal Radioassay for Serum Vitamin B12. A Simple Modification To Improve Intrinsic Factor Reliability

Blood ◽

10.1182/blood.v34.3.385.385 ◽

1969 ◽

Vol 34 (3) ◽

pp. 385-390 ◽

Cited By ~ 16

Author(s):

R. S. HILLMAN ◽

M. OAKES ◽

C. FINHOLT

Keyword(s):

Vitamin B12 ◽

Intrinsic Factor ◽

Serum Vitamin ◽

Human Albumin ◽

Albumin Solution ◽

Simple Modification ◽

Control Tube ◽

Simple Substitution ◽

Human Albumin Solution

Abstract Reliable binding of vitamin B12 by intrinsic factor (IF) is essential in the hemoglobin-coated charcoal radioassay for serum vitamin B12 as described by Lau et al.4 The fact that some IF preparations bind less B12 in the saline IF control tube than in those tubes containing serum can result in a falsely low measurement of unknown sera. This may be avoided by the simple substitution of 0.5 ml. of 5 per cent human albumin solution for the saline in the IF control tube.

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A case of thrombotic microangiopathy of unknown aetiology, clinically presenting as an acute surgical abdomen

BMJ Case Reports ◽

10.1136/bcr-2019-230553 ◽

2019 ◽

Vol 12 (11) ◽

pp. e230553

Author(s):

Lydia Madeleine Isabel Stratford ◽

Isaac Nahoor ◽

Kataryna Dos Santos ◽

Antonio Alves Dos Santos

Keyword(s):

Total Colectomy ◽

Human Albumin ◽

Emergency Laparotomy ◽

Unknown Aetiology ◽

Albumin Solution ◽

Successful Recovery ◽

Red Blood Cell Transfusions ◽

Human Albumin Solution ◽

Subsequent Rehabilitation ◽

Severe Colitis

A 48-year-old woman presented with severe abdominal pain, bilious vomiting and bloody diarrhoea for 1 day. On examination, she was haemodynamically unstable, febrile and clinically had an acute surgical abdomen. She had markedly raised inflammatory markers, neutrophils and deranged renal function. A CT abdominal scan revealed severe colitis and thickening throughout the length of the colon. The patient was stabilised and underwent emergency laparotomy resulting in total colectomy and end ileostomy formation. Postoperatively, she required several units of human albumin solution, red blood cell transfusions and octaplex (prothrombin complex) to prevent further bleeding. An inpatient haematology review revealed a hypocomplementaemia (C3/C4), low immunoglobulin (IgG, IgM, IgA) and peripheral blood films revealed schistocytosis indicating microangiopathic haemolytic anaemia. Bowel histology supported this, demonstrating circumferential lymphocytic phlebitis with thrombi and mucosal haemorrhage, necrosis and ulceration. The patient went on to suffer multiple ischaemic strokes before undergoing plasmapheresis, subsequent rehabilitation and making a successful recovery.

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Effect of Human Plasma Proteins on Stabilisation of Platelet Anti-Aggregatory Activity of Prostacyclin

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456328201900408 ◽

1982 ◽

Vol 19 (4) ◽

pp. 241-244 ◽

Cited By ~ 29

Author(s):

D P Mikhailidis ◽

A M Mikhailidis ◽

P Dandona

Keyword(s):

Biological Activity ◽

Fatty Acid ◽

Protective Effect ◽

Clinical Relevance ◽

Plasma Proteins ◽

Human Albumin ◽

Albumin Solution ◽

Degree Of Protection ◽

Buffer Solutions ◽

Human Albumin Solution

Following the demonstration that biological activity of prostacyclin is more stable in plasma than in buffer solutions at physiological pH, we investigated the possibility that a plasma protein may be responsible for this effect. The duration of platelet anti-aggregatory activity of prostacyclin in fatty acid-free human albumin solution was significantly longer than in buffer solutions. The duration of this ‘protection’ was proportional to the concentration of albumin; α, β, and γ-globulin preparations had no ‘protective’ effect. The degree of ‘protection’ by albumin solutions was lower than that by plasma despite identical albumin concentrations. This discrepancy may in part be explained by the tendency of plasma to become alkaline on standing, a change that would tend to stabilise prostacyclin. The clinical relevance of our findings is discussed.

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Human albumin solution for resuscitation and volume expansion in critically ill patients

10.1002/14651858.cd001208 ◽

2002 ◽

Cited By ~ 5

Author(s):

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Volume Expansion ◽

Human Albumin ◽

Albumin Solution ◽

Human Albumin Solution

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A Safety Study of Albumex® 5, a Human Albumin Solution Produced by Ion Exchange Chromatography

Vox Sanguinis ◽

10.1159/000462115 ◽

1996 ◽

Vol 70 (4) ◽

pp. 198-202

Author(s):

M. Wolf ◽

H. Kronenberg ◽

A. Dodds ◽

P. Miach ◽

J. Isbister ◽

...

Keyword(s):

Ion Exchange ◽

Human Albumin ◽

Ion Exchange Chromatography ◽

Exchange Chromatography ◽

Albumin Solution ◽

Safety Study ◽

Human Albumin Solution

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STUDIES ON THE CONGLUTINATION REACTION, WITH SPECIAL REFERENCE TO THE NATURE OF CONGLUTININ

Journal of Experimental Medicine ◽

10.1084/jem.86.4.267 ◽

1947 ◽

Vol 86 (4) ◽

pp. 267-284 ◽

Cited By ~ 19

Author(s):

Alexander S. Wiener ◽

Jane G. Hurst ◽

Eve B. Sonn-Gordon

Keyword(s):

Immune Globulin ◽

Total Protein ◽

Plasma Proteins ◽

Protein Concentration ◽

Human Albumin ◽

Specific Adsorption ◽

Albumin Solution ◽

X Protein ◽

Cent Concentration ◽

Human Albumin Solution

1. Dilution of pooled plasma with more than an equal volume of saline solution destroys its ability to produce conglutination of red cells sensitized by univalent antibody. This can be correlated with Pedersen's work showing that X-protein is readily dissociated by dilution. The observation explains the discrepancy between the reports of British and American workers regarding the incidence of Rh "agglutinins" in the serum of Rh-negative mothers of erythroblastotic babies. 2. Plasma has a higher conglutinating activity than serum as shown by the finding that plasma gives titers on the average more than twice as high as those obtained with serum. The greater activity of plasma would seem due to the presence of fibrinogen which is apparently an important component of the colloidal complex of plasma proteins making up conglutinin. 3. Aside from its action in precipitating fibrinogen, heating at 56°C. for onehalf hour has no harmful effect on conglutinin. 4. Fetal plasma and serum yield much lower conglutination titers than adult plasma and serum, indicating that fetal blood is deficient in conglutinin. After birth, there is generally a marked increase in the conglutinin content of the blood. There is little or no variation in the conglutinin activity of sera from different normal adult individuals. 5. The use of whole citrated blood in exchange transfusion to an erythroblastotic baby caused an appreciable rise in the total plasma proteins after the transfusion and a corresponding increase in the conglutinating activity. When however, in another instance, two-fifths of the plasma was removed from the donor's blood and replaced with saline, there was no appreciable change in the protein concentration or conglutinin activity of the infant's plasma after the transfusion. 6. The fortification of pooled plasma by mixing 4 parts of it with 1 part of 25 per cent human albumin solution markedly increased its conglutinin content as shown by a fourfold increase in the conglutination titers obtained. Addition of less or more than this optimal amount of albumin resulted in lower titers. The 25 per cent human albumin solution itself yielded titers only half as high as did unmodified pooled plasma and was difficult to work with because of its high viscosity. Similar results were obtained in experiments with immune globulin solutions and pooled plasma. 7. Albumin solutions of less than 12.5 per cent concentration had little or no conglutinin activity; similarly, immune globulin solutions of less than 4.6 per cent concentration gave only relatively low titers when used as conglutinin. Yet, mixtures of these dilute solutions in certain optimal proportions yielded solutions with conglutinin activities considerably higher than that of pooled plasma. The albumin-globulin ratio in the mixtures giving the best results proved to be approximately the same as the albumin-globulin ratio of normal human serum or plasma. 8. Suitable mixtures of albumin and globulin solutions with a total protein concentration equal to that of normal plasma gave conglutination titers about four times as high as those obtained with unmodified pooled plasma. This suggests that there may be substances in normal plasma which tend to maintain the albumin and globulin in molecular dispersion. Another possibility is that in the fractionation process the albumin and globulin are rendered less hydrophilic, thus increasing their tendency to form colloidal aggregates. 9. The experiments described support the theory that clumping of cells by univalent antibodies in plasma media occurs in two stages, namely, (1) specific adsorption of univalent antibodies, and (2) non-specific adsorption of conglutinin by the sensitized cells causing them to stick together. The experiments further support the concept of conglutinin or X-protein as a colloidal aggregate of plasma proteins. Finally, they demonstrate that the intensity of the clumping (conglutination—not agglutination) depends on the quantity and quality of conglutinin and not merely on the total protein content of the medium of suspension.

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