Safety and Ef(cid:976)icacy of the Thai Red Cross Society Albumin
Replacement for Therapeutic Plasma Exchange
Phandee Watanaboonyongcharoen MD1,2,3, Metha Apiwattanakul MD4, Sompis Santipong MT2, Jutaluk Jaipian MT2,
Jettawan Siriaksorn MD2, Ponlapat Rojnuckarin MD2,5
Affiliation :
1 Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
2 Transfusion Medicine Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
3 Renal Immunology and Renal Transplant Research Unit, Bangkok, Thailand
4 Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
5 Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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 ef(cid:976)icacy 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 (cid:976)ifty-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 (cid:976)irst patient had two events of
hypotension. He previously took angiotensin converting enzyme inhibitor. The second patient complained of nausea after (cid:976)inishing
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 signi(cid:976)icant (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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