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Thread: Any alternatives for albumin for preop JW Patient

  1. #1
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    Any alternatives for albumin for preop JW Patient

    Elderly JW male was admited to Hospital with hyperglycemia and Ketoacidosis. He had a history of continuous vomiting for the past 2 days.
    Past history of Gastric Ulcer resulting in Gastric Outlet obstruction 1 month ago which was partially resolved by endoscopic dilatation of pylorus.
    The surgeon feels this has recurred now and wants to resolve the obstruction with a Gastro jejenostomy by pass once the blood glucose levels come down.
    However one issue is the patient has a low albumin level of 2.6 and the surgeon feels that with a low albulminlevel there may be a 10-25% post op risk of burst abdomen even though it is a laproscopy and a smaller chance of anastomotic leak.
    The patient is undecided about taking albumin as it is a blood fraction and wants to know if there any viable alternatives.
    The surgeon was told about colloids such as heta and penta starch and gelatin, dextran etc but feels this will not suffice
    Please advise
    Dr Amit Char
    Editorial Team

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  3. #2
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    Ulcer management

    I have attached some abstracts that may be helpful.
    Attached Files Attached Files

  4. #3
    Managing Editor Jan B. Wade's Avatar
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    Resolve patients personal choice

    Quote Originally Posted by amitchar View Post
    Elderly JW male was admited to Hospital with hyperglycemia and Ketoacidosis. He had a history of continuous vomiting for the past 2 days.
    Past history of Gastric Ulcer resulting in Gastric Outlet obstruction 1 month ago which was partially resolved by endoscopic dilatation of pylorus.
    The surgeon feels this has recurred now and wants to resolve the obstruction with a Gastro jejenostomy by pass once the blood glucose levels come down.
    However one issue is the patient has a low albumin level of 2.6 and the surgeon feels that with a low albulminlevel there may be a 10-25% post op risk of burst abdomen even though it is a laproscopy and a smaller chance of anastomotic leak.
    The patient is undecided about taking albumin as it is a blood fraction and wants to know if there any viable alternatives.
    The surgeon was told about colloids such as heta and penta starch and gelatin, dextran etc but feels this will not suffice
    Please advise
    Doctor,

    This seems to be a matter of helping the patient understand albumin and blood fractions. You state that this is one of Jehovah's Witnesses, have you contacted his congregation or the local Hospital Liaison Committee (support for Jehovah's Witnesses facing health care issues related to blood) if there is such a thing in your area? I am certain either would be more than willing to help your patient through the decision process.

    If the local support system seems to fall short (I have no idea where you are in India) you can contact India's Branch for Jehovah's Witnesses.

    Jan Wade
    Blood Management Consultant
    206 914-0068
    Mr. Jan B. Wade
    Admin
    Email

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  5. #4
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    Yes they have contacted the HLC who are well equipped to deal with the issue especially as they are in Bangalore, India where the branch is located. However there were queries about any albumin substitutes and as a result the question was posted.

    Also thanks for the material on recombinant Human serum albumin-rHSA. I was not aware also, of it being combined with"synthetic Heme" so as to form albumin-heme which has the potential for an oxygen carrying substitute.

    If anyone has any more information on this it would be highly appreciated
    Dr Amit Char
    Editorial Team

  6. #5
    Hypoalbuminemia does not meet our hospital's criteria for using Albumin. I believe the best way to get an increase in serum albumin is nutritionally such as with TPN.

  7. #6

    Albumen Alternatives

    What does burst abdomen mean? Are you referring to wound dehiscence? Does the surgeon think this might occur secondary to muscle wasting, and a poor nutritional state?

    Paul G. Loubser, MD
    National Cardiac Anesthesia Consultants, PA

  8. #7
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    Thank you for the fact that TPN may be a more appropriate treatment.
    Also the surgeon was referring to wound dehiscence. He also feels GJ anastomotic leak could be a possibility secondary to hypoalbuminemia. Any information regarding adverse effects post op due to hypoalbuminemia would be highly appreciated.
    Dr Amit Char
    Editorial Team

  9. #8
    Managing Editor Jan B. Wade's Avatar
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    Sop?

    Along with nutrition, which should be a given when a patients condition is deteriorating, also consider proceeding with less intravenous dilution. Low albumin can be caused by over dilution. We tend to start fluids and keep them running. Even the TPN will exacerbate dilution. Also Intensivists usually consider the decrease in hepatic production when they see hypoalbuminic patients, right?

    Any headway with the patient on accepting albumin? You mention their are plenty of resources available, so I assume he will make a decision one way or the other...just curious.
    Mr. Jan B. Wade
    Admin
    Email

    Click here for the Best Questions and Answers regarding Transfusion Alternatives and Patient Blood Management.




  10. #9
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    The patient decided to accept the fraction and is recovering now after the surgery although still in ICU for the next 48 hours
    Dr Amit Char
    Editorial Team

  11. #10
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    The patient decided to accept the fraction and is recovering now after the surgery although still in ICU for the next 48 hours. However I was still curious about this synthetic heme-albumin. Any more studies comparing it to its natural congener --Hemoglobin?
    Dr Amit Char
    Editorial Team

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