J Med Assoc Thai 2018; 101 (11):1563-7

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Safety and Efficacy of the Thai Red Cross Society Albumin Replacement for Therapeutic Plasma Exchange
Watanaboonyongcharoen P Mail, Apiwattanakul M , Santipong S , Jaipian J , Siriaksorn J , Rojnuckarin P

Background: Albumin replacement has been widely used in various conditions. However, there had been problems of rising cost and supply shortage of imported albumin in Thailand. To solve the problem, the National Blood Centre had established a plasma fractionation plant to manufacture plasma products including albumin.

Objective: To evaluate the safety and efficacy of the Thai Red Cross Society [TRCS] albumin.

Materials and Methods: To minimize confounder effects of underlying conditions, only patients that underwent therapeutic plasma exchange [TPE] using the TRCS albumin replacement from two hospitals were included. Serum albumin levels were measured before and after TPE. The adverse effects were recorded.

Results: One hundred fifty-six TPEs in 35 patients were included. The median total plasma volume was 3,000 (range 1,750 to 4,200) mL. Although the corrected calcium level was low (<8 mg/dL) in 3.2% (5/156) before the procedure, no clinical manifestation of hypocalcemia was detected. Adverse effects were observed during the TPE in two patients. The first patient had two events of hypotension. He previously took angiotensin converting enzyme inhibitor. The second patient complained of nausea after finishing TPE. The incidence of adverse effects was 1.9% (3/156). As a historical control, the incidence of TPE adverse effects was 1.6% (2/125) when commercial albumin was used in 2014. The difference was not statistically different (p = 1.000). Median serum albumin levels pre-TPE and post-TPE were 3.6 (1.9 to 4.4) and 3.9 (2.4 to 5.0) g/dL, respectively. The increase in serum albumin after TPE was statistically significant (p<0.001).

Conclusion: The authors demonstrated that the TRCS albumin was safe and effective in maintaining albumin levels in patients undergoing TPEs.

Keywords: Therapeutic plasma exchange, Albumin

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