Abstract
The Japanese Health, Welfare and Labor Ministry in 2006 published guidelines for the use of blood products which mandated that the ratio of volume of albumin/volume of red cell products (At/RBCt) be lower than 2.0. At Fukuoka University Hospital, this ratio has been about 4 for the past 10 years. The Transfusion Service analyzed albumin usage in March 2006 and proposed to lower the value by: 1) limiting consecutive orders of albumin to two days; 2)removing the most concentrated albumin product, 25% albumin, from use; and 3) lowering the target serum albumin level after administration because method of analysis changed from the bromcresol green method to the improved bromcresol purple method. Promotion of appropriate albumin usage began in July 2006 after agreement to these proposals by the Transfusion Committee.
We analyzed the consumption of albumin from March to May of 2006 and of 2007 to determine the effectiveness of this effort. The number of patients receiving albumin decreased from 300 to 240 and the amount of total albumin consumed decreased from 23,657g to 14,673g. The median dose and the median number of days of administration of hypertonic albumin per patient decreased from 75g to 40g and from 3 to 2, respectively. The median serum albumin level after administration decreased to just below the lowered target level for isotonic albumin, but was still above the corresponding target level for hypertonic albumin. Lastly, the proportion of albumin used appropriately increased from 47% to 68%, but At/RBCt decreased only to 2.6 from 3.0. Clearly, more effort is needed to reach the goal of 2.0.
