Clinical Science (2005) 108, 217-224 - A. Hedin and R.G. Hahn - Volume expansion and protein clearance during infusion of 5% albumin and autologous plasma

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Clinical Science (2005) 108, (217–224) (Printed in Great Britain)

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Volume expansion and plasma protein clearance during intravenous infusion of 5% albumin and autologous plasma

Annika HEDIN and Robert G. HAHN

Department of Anaesthesia and Intensive Care, South Hospital, S-118 83 Stockholm, Sweden

Key words: albumin, antithrombin, fibrinogen, pharmacokinetics, transcapillary leak.

Abbreviations: aPTT, activated partial thromboplastin time; Hb, haemoglobin; INR, international normalized ratio; MCV, mean corpuscular volume; RBC, red blood cell; t_1/2, half-life.

Correspondence: Professor Robert G. Hahn (email robert.hahn@sodersjukhuset.se).

Autologous plasma may be used to replace plasma volume and plasma proteins during surgery, but its effectiveness is largely unknown. In the present study, the characteristics of predonated frozen and thawed autologous plasma were compared with those of 5% albumin in 15 male volunteers who received 10 ml/kg of body weight of these colloids as intravenous infusions over 30 min. Venous blood was sampled and urine was collected over 8 h to outline the volume expansion and blood–interstitial fluid space transport of three plasma proteins (albumin, fibrinogen and antithrombin) by means of mass balance analysis. The maximum plasma dilution of 5% albumin and autologous plasma averaged 17 and 21% respectively, and their half-lives were 2.5 and 2.9 h respectively (P<0.03). The between-subject variability in dilution was most pronounced for autologous plasma. Transport of protein from blood to the interstitial space occurred faster when the infused fluid contained the protein in question. The rate was highest at 60 min, and the process was still in progress at 8 h when approx. 60% of the infused albumin, 45% of the fibrinogen and 75% of the infused antithrombin had been translocated to the interstitial fluid space. In contrast with the proteins, excess plasma water was removed by urinary excretion. It is concluded that the volume expansion is equivalent for the two colloid fluids, although it is more predictable for 5% albumin. The transport of protein outlasted the volume expansion.