The clinical use of albumin: a topic for Transfusion Medicine.

Abstract

This issue of Blood Transfusion contains various articles with a very strong clinical impact dealing with the appropriateness of different aspects of transfusion therapy: the transfusion of blood1, albumin2,3, antithrombin and prothrombin complex concentrates4. These articles are in part drawn from presentations at the latest National Congress of the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) and in part the result of a specific working group commissioned by SIMTI itself to produce recommendations on the correct use of blood components and plasma derivatives. I believe that it is important to highlight the ever greater attention that is being paid in the practice of Transfusion Medicine to a wider and more global use of transfusion therapy, including plasma-derived drugs. In fact, treatment with albumin or some plasma derivatives is very often part of a therapeutic programme that also involves the transfusion of blood components and the evaluations of the appropriateness of their use are often the same as those that must be carried out, in the same patients, on the use of blood components such as fresh-frozen plasma. In particular, the use and distribution of albumin in recent times and still in many hospitals are guaranteed by specialists outside the Transfusion Service: internists, intensive care specialists, hepatologists and pharmacists. Furthermore, it is known that albumin is administered considerably more frequently in Italy than in other European countries and this has led to reflections on the mechanisms of verifying the appropriateness of its use. The first of these mechanisms of verifications has been, in many hospitals, the compulsory compilation of a form, by the requesting doctor, documenting the patient’s diagnosis and the specific indications for the use of the albumin. This simple measure has led in many cases to a reduction, sometimes drastic, in the use of albumin. More recently the verification of the appropriateness of the use of albumin has been incorporated in the procedures for verifying the appropriateness of the transfusion of blood components and in numerous settings the distribution of the drug is now also guaranteed, or controlled, by the Transfusion Service. The fundamental reasons for this can be found in the wider context that enables transfusion doctors to provide more complete and more appropriate solutions to the needs of patients and ward doctors, in the Transfusion Services’ possibility of guaranteeing rigorous traceability, thanks to the computer systems in use in these Services, of the plasma derivative from its collection from the donor through to its administration to the patient, and in the fact that although ‘self-control’ systems of appropriateness of use, such as those involving the compilation of request forms, are important, a ‘peer review’ system is undoubtedly more effective. It was on this scientific and educational background that the “Recommendations on the use of albumin” were produced by SIMTI5 and published and synergies were searched for, in this case on the use of albumin, with illustrious specialists such as the authors of the two articles on this subject published in this issue of the journal2,3.