Australian Red Cross Blood Service

Albumex® 4

Important: Quarantining of Albumex (4% and 20%) by CSL Behring – 8 March 2012

CSL manufactures two albumin products, Albumex® 4 (40 g/L) and Albumex® 20 (200 g/L).

Albumin usually has a clear to pale yellow colour but may occasionally have a green discolouration, which is attributed to small amounts of biliverdin.

Biliverdin is a green-coloured breakdown product of haemoglobin and is carried by albumin in human plasma. This colour is quite normal and is completely harmless.

Since albumin is available in two concentrations, ensure that you administer the correct concentration because error could result in severe circulatory overload or sudden cardiac failure.

Always read and refer to the product information sheet prior to the administration of Albumex® 4 or Albumex® 20.

Albumex® 4

Albumex® 4 (Human Albumin 40 g/L) is indicated in shock associated with significant hypoalbuminaemia (albumin < 25 g/L), therapeutic plasmapheresis and in cardiothoracic surgery.

Albumex® 4 product information [on www.csl.com.au]

This link takes you to CSL's web information about Albumex® 4. You can download the product information (PI) sheet from this web page.

The PI details the pharmacology, indications, contraindications, precautions, adverse effects, use in pregnancy & lactation, adverse effects, and dosage & administration of Albumex® 4.

Albumex® 20

Albumex® 20

Albumex® 20 (Human Albumin 200 g/L) is given to critically ill patients with extremely low albumin. It is also indicated in burns, paracentesis of ascites and haemodialysis.(1,2)

Albumex® 20 product information [on www.csl.com.au]

This link takes you to CSL's web information about Albumex® 20 . You can download the product information (PI) sheet from this web page.

The PI details the pharmacology, indications, contraindications, precautions, adverse effects, use in pregnancy & lactation, adverse effects, and dosage & administration of Albumex® 20 .

Are green-tinged albumin solutions safe to use?

Albumin solutions that are straw-coloured or green are normal and safe to use.

CSL Behring uses chromatographic fractionation techniques to manufacture albumin products with >99% purity.(3)

CSL Behring’s albumin products, consistent with other commercially available products, may vary in colour from a pale straw to amber to a greenish tint  depending on the proportions of bilirubin and its degradation products—lumirubin and biliverdin.(4)

In the human body, erythrocytes are destroyed in the reticulo-endothelial system (spleen, lymph nodes, bone marrow) after the termination of their normal life span.

This process releases haemoglobin, which is processed to bilirubin which then binds to albumin and is transported to the liver.

The majority of this bilirubin is then conjugated and excreted via the bile duct in the liver. Bilirubin is sensitive to light and degrades predominantly to lumirubin, which has a yellow pigment and also results in the generation of small amounts of biliverdin which is green.(5)

References

1. Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology. 2012;55(4):1172–1181.
2. Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009;49:2087–2107.
3. Che Y, Wilson F, Bertolini J, Schiff P, Maher D.W. Impact of Manufacturing Improvements on Clinical Safety of Albumin: Australian Pharmacovigilance Data for 1988-2005. Critical Care & Resuscitation 2007;8(4):334–338.
4. CSL Bioplasma. Albumex 4 - Product Information. CSL Limited, Australia, 2008.
5. Onishi S, Itoh S, Isobe K, Ochi M, Kunikata T, Imai T. Effect of the Binding of Bilirubin to either the First Class or the Second Class of Binding Sites of the Human Serum Albumin Molecule on its Photochemical Reaction. Biochem J 1989;257(3):711–714.