An 8-Year Retrospective Review of Human Albumin Solution (HAS) Use August 2015 to March 2023; Guy's and St Thomas' NHS Foundation Trust (GSTFT)

Abstract

Background: HAS is widely used in clinical practice for a variety of haematological, renal, neurological, respiratory and metabolic conditions. A United Kingdom shortage in 2015 prompted a demand management guideline incorporating the American Society for Apheresis (ASFA) indications ¹ and GSTFT criteria ² for other indications.

Objectives:The objective of this study was to evaluate the indications for HAS usage following the introduction of the GSTFT demand management guideline.

Methods: We audited HAS usage from August 2015 to March 2023 at GSTFT. Data was entered in SPSS version 20, with categorical variables described as frequencies and percentages.

Results:

4816 patients received HAS during the study period, totaling 21,231 infusions.

We recorded 16,772 (79%) infusions for 20% HAS in 4,145 patients. The indications for 20% HAS included; volume resuscitation for hypovolaemia 5237 (31%), severe sepsis/septic shock 3528 (21%), acute lung injury and severe respiratory failure 2987 (18%), paracentesis 2402 (14%), hepatorenal syndrome 1710 (10%), childhood nephrotic syndrome 685 (4.1%) and spontaneous bacterial peritonitis 223 (1.3%) (Table 1). According to GSTFT criteria infusions were recorded in the following indication categories: Red 7099 (42.3%), Blue 4436 (26.4%) and Grey 5237 (31.2%).

A total of 4459 (21%) infusions were recorded for 4.5 and 5% HAS. A total of 3628 (81%) infusions were used for plasma exchange (PEX) in 305 patients; 2817(76.99%) ASFA category I, 445(12.03%) category II, 290(7.97%) category III and 92 (2.5%) for indications not specified according to ASFA; 826 infusions (18.5%) were for volume resuscitation for hypovolaemia (Grey indication) in 389 patients, the remaining 5 infusions (0.1%) were in 3 patients for burns and thermal injuries (Table 1).

Major indications for PEX included post-transplant focal segmental glomerulosclerosis 911 infusions (20%) in 9 patients, familial hypercholesterolaemia 738 infusions (16%) in 5 patients, antibody mediated rejection 439 infusions (10%) in 71 patients (Table 2).

Conclusions: This report provides a rare long term retrospective review of total albumin usage in a large UK tertiary referral center. The majority (97.5%) of PEX HAS indications were within ASFA guidelines. Aside from apheresis the main indication for HAS was volume resuscitation, a grey indication, where evidence is weak.

REFERENCES

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