Author: Huang Zhifeng
Review: Chen Chuxiong
< span>Unit: Sun Yat-sen Memorial Hospital of Sun Yat-sen University
Source: Yixian Pharmacy V
What is a protein needle? In our daily life, we often hear protein needles, but what exactly is it? Simply put, the so-called protein injection refers to human albumin injection. So, what does albumin do? What are the misunderstandings of human serum albumin in clinical application?
Then take you to learn more. The structure, metabolism and function of albumin moleculeAlbumin is the main protein (35～ 50 g/L), accounting for about 50% of plasma protein, which is synthesized by hepatocytes, therefore, patients with impaired liver function or liver surgery are prone to hypoproteinemia. Albumin is mainly degraded in muscle, intestine, liver and kidney, and many other tissues are also involved in its catabolism, metabolizing about 6% to 10% of its total daily. its main role:
maintain normal colloidal osmotic pressure in plasma, regulate tissue and blood vessels The dynamic balance of water between them can correct blood volume deficiency; secondly, it can be used for adjuvant treatment of hypoalbuminemia. Of course there are many other biological properties: such as scavenger and detoxification of reactive oxygen species and reactive nitrogen species.
Human albumin is a blood product?
Yes, human albumin injections are blood products.
According to the current Chinese Pharmacopoeia definition:blood products are produced by healthy people. Plasma or specifically immunized human plasma, plasma protein fractions that have been isolated, purified or prepared by recombinant DNA technology, and blood cell formed components. The blood products commonly referred to in my country are plasma protein products, which mainly include different categories such as albumin, immunoglobulin, coagulation factors, anticoagulation proteins and protease inhibitors. What exactly is human albumin for? Currently recognized clinical indications for human serum albumin include: 1. Shock caused by blood loss, trauma and burns; < span>2. Increased intracranial pressure due to cerebral edema and brain injury;3. Prevention and treatment of hypoalbuminemia; 4. Edema or ascites caused by liver cirrhosis or kidney disease ;5, neonatal hyperbilirubinemia; 6, adult respiratory distress syndrome; 7, for cardiopulmonary bypass, burns and adjuvant therapy for hemodialysis. The American “Albumin Clinical Application Guidelines” pointed out that the correct clinical application of albumin includes shock, burns, acute respiratory distress syndrome, cardiopulmonary bypass, and occasionally in acute liver failure, ascites, Renal dialysis, applications that require further observation include neonatal jaundice and mercury poisoning. Unreasonable clinical applications include nutritional supplementation, nephrotic syndrome, and chronic liver cirrhosis.
which is clearly unreasonable as a nutritional supplement. For nephrotic syndrome, if diuretic therapy fails in patients with acute severe peripheral edema or pulmonary edema, 25% albumin combined with diuretic therapy can be used for a short period of time. For patients with progressive liver cirrhosis leading to ascites, dietary adjustment (sodium restriction of 2 g per day) and diuretic therapy should be the first choice, if the above treatment fails or cannot be tolerated, or there is a large amount of ascites (>5L) For patients who need abdominal paracentesis, albumin (25%) or non-protein colloid solution can be given. Five misunderstandings in the use of human albumin1. Improve immunity Some people think that injection of human albumin can enhance physical fitness, improve immunity, and delay aging. Therefore, more and more healthy people take the initiative to request albumin injection. However, it is globulin, not albumin, that is involved in the body’s immune mechanism. Large-dose infusion of albumin, not only can not improve immunity, but may cause the body’s immune function to decline. This is because albumin preparations contain certain biological activitiesSubstances, such as trace endotoxin, kallikrein, and trace α1-acid glycoprotein, may have “interfering” effects on the immune function of the human body. 2. As a nutritional supplement for healthy peopleIn fact, albumin as a nitrogen source can synthesize protein faster than It is slow, and the half-life of albumin is as long as 16 to 21 days. It needs to be decomposed into free amino acids after a period of time after it is injected into the human body before it can synthesize the protein needed by the body itself. Therefore, the albumin inputted on the same day cannot quickly exert nutrition. effect. In addition, studies have found that the proportion of essential amino acids contained in albumin is very unbalanced, especially the lack of tryptophan, one of the important amino acids used to synthesize other proteins. Aspects are far lower than balanced amino acid preparations, so albumin is not suitable as a nutritional supplement. In conclusion, the root cause of malnutrition is insufficient intake or utilization of nitrogen and calories in the body. Therefore, for malnourished patients, sufficient and reasonably matched energy (fat emulsion and glucose) and nutritional substrates (balanced amino acid preparations) should be provided, which is the key. 3. Serum protein concentration is not detected before useAn important reference index for clinical use of human serum albumin is the serum albumin concentration, and its normal concentration range is 35 to 50 g/L. In actual clinical practice, for patients with serum albumin concentration in the normal range, or patients without serum albumin concentration detection, human albumin infusion is given. All belong to off-label use. Generally speaking, the application of human serum albumin is indicated only when the serum albumin concentration is lower than 25g/L. 4. Albumin may transmit infectious diseases such as hepatitis BAlthough this possibility cannot be completely denied theoretically sex. However, the currently used human albumin is inactivated by heating at 60°C for 10 hours in the presence of a stabilizer. Under such conditions, HBV, HCV, HIV and other viruses have lost their infectivity, and albumin has no antigenicity and can be infused repeatedly. Therefore, transfusion of albumin is actually much safer than transfusion of plasma or whole blood. Of course, the possibility of infection cannot be completely ruled out. 5. Albumin is safe and has no side effects. Anyone can use it.Drugs are a double-edged sword. There are therapeutic effects, but also may lead to the occurrence of side effects. The same is true for albumin. Some patients have allergic reactions to albumin. Therefore, albumin should be disabled for those with a history of allergic reactions to albumin. In addition, it is also contraindicated in patients with severe anemia and heart failure. Albumin infusion also occasionally produces adverse reactions such as nausea, vomiting, fever, headache, chills, urticaria, and tachycardia. Anaphylactic shock may be life-threatening and should be treated in time. For patients with hypertension, pulmonary edema, renal insufficiency, etc., especially those with heavy blood volume load, if the infusion of human serum albumin is too fast, it can lead to increased blood pressure or aggravated edema, so attention should be paid to monitoring. Diuretics such as furosemide can lower blood volume when necessary. Final reminder:Human albumin is a drug, and it is a prescription drug with strict indication requirements. If it is used without authorization, it will not only waste money , and may have serious consequences.
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