Label: PLASBUMIN (albumin- human solution

Albumin (Human) 5%, USP (Plasbumin®-5) is made from large pools of human venous plasma by the Cohn cold ethanol fractionation process. Part of the fractionation may be performed by another licensed manufacturer. It is prepared in accordance with the applicable requirements established by the U.S. Food and Drug Administration.

Plasbumin-5 is a 5% sterile solution of albumin in an aqueous diluent. The preparation is stabilized with 0.004 M sodium caprylate and 0.004 M acetyltryptophan. The aluminum content of the product is not more than 200 µg/L. The approximate sodium content of the product is 145 mEq/L. Plasbumin-5 is clear, slightly viscous, almost colorless to yellow, amber or green. It contains no preservative. Plasbumin-5 must be administered intravenously.

Each vial of Plasbumin-5 is heat-treated at 60°C for 10 hours against the possibility of transmitting the hepatitis viruses.

Additionally, the manufacturing process was investigated for its capacity to decrease the infectivity of an experimental agent of transmissible spongiform encephalopathy (TSE), considered as a model for the variant Creutzfeldt-Jakob disease (vCJD) and Creutzfeldt-Jakob disease (CJD) agents.(8-11) The production steps from Pooled Plasma to Effluent IV-1 in the Plasbumin-5 manufacturing process have been shown to decrease TSE infectivity of that experimental model agent (a total of ≥7.0 logs). These studies provide reasonable assurance that low levels of vCJD/CJD agent infectivity, if present in the starting material, would be removed.

Plasbumin-5 is oncotically equivalent volume for volume to normal human plasma.

When administered intravenously to an adequately hydrated subject, the oncotic (colloid osmotic) effect of Plasbumin-5 is to expand the circulating blood volume by an amount approximately equal to the volume infused. It is primarily used in the treatment of shock associated with hemorrhage, surgery, trauma, burns, bacteremia, renal failure, and cardiovascular collapse.(1)

Albumin is a transport protein and it may be useful in severe jaundice in hemolytic disease of the newborn.(1) This could also be of importance in acute liver failure where albumin might serve the dual role of supporting plasma oncotic pressure, as well as binding excessive plasma bilirubin.(1)

Emergency Treatment of Hypovolemic Shock

Plasbumin-5 is iso-oncotic with normal plasma and on intravenous infusion will expand the circulating blood volume by an amount approximately equal to the volume infused. In conditions associated mainly with a volume deficit, albumin is best administered as a 5% solution (Plasbumin-5); but where there is an oncotic deficit, Albumin (Human) 25%, USP (Plasbumin®-25) may be preferred. This is also an important consideration where the treatment of the shock state has been delayed. If Plasbumin-25 is used, appropriate additional crystalloid should be administered.(1)

Crystalloid solutions in volumes several times greater than that of Plasbumin-5 may be effective in treating shock in younger individuals who have no preexisting illness at the time of the incident. Older patients, especially those with preexisting debilitating conditions, or those in whom the shock is caused by a medical disorder, or where the state of shock has existed for some time before active therapy could be instituted, may not tolerate hypoalbuminemia as well.(1)

Removal of ascitic fluid from a patient with cirrhosis may cause changes in cardiovascular function and even result in hypovolemic shock. In such circumstances, the use of albumin infusion may be required to support the blood volume.(1)

Burn Therapy

An optimal therapeutic regimen with respect to the administration of colloids, crystalloids, and water following extensive burns has not been established. During the first 24 hours after sustaining thermal injury, large volumes of crystalloids are infused to restore the depleted extracellular fluid volume. Beyond 24 hours, albumin can be used to maintain plasma colloid osmotic pressure. Plasbumin-25 may be preferred for this purpose.(1)

Cardiopulmonary Bypass(1)

With the relatively small priming volume required with modern pumps, preoperative dilution of the blood using albumin and crystalloid has been shown to be safe and well-tolerated. Although the limit to which the hematocrit and plasma protein concentration can be safely lowered has not been defined, it is common practice to adjust the albumin and crystalloid pump prime to achieve a hematocrit of 20% and a plasma albumin concentration of 2.5 g per 100 mL in the patient.

Acute Liver Failure(1)

In the uncommon situation of rapid loss of liver function, with or without coma, administration of albumin may serve the double purpose of supporting the colloid osmotic pressure of the plasma as well as binding excess plasma bilirubin.

Sequestration of Protein Rich Fluids(2)

This occurs in such conditions as acute peritonitis, pancreatitis, mediastinitis, and extensive cellulitis. The magnitude of loss into the third space may require treatment of reduced volume or oncotic activity with an infusion of albumin.

Situations in Which Albumin Administration is Not Warranted(1)

In chronic nephrosis, infused albumin is promptly excreted by the kidneys with no relief of the chronic edema or effect on the underlying renal lesion. It is of occasional use in the rapid “priming” diuresis of nephrosis. Similarly, in hypoproteinemic states associated with chronic cirrhosis, malabsorption, protein losing enteropathies, pancreatic insufficiency, and undernutrition, the infusion of albumin as a source of protein nutrition is not justified.

Certain patients, e.g., those with a history of congestive cardiac failure, renal insufficiency or stabilized chronic anemia, are at special risk of developing circulatory overload. A history of allergic reaction to albumin is a specific contraindication for usage.

Plasbumin-5 is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, and, theoretically, the Creutzfeldt-Jakob Disease (CJD) agent that can cause disease. The theoretical risk for transmission of CJD is considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for albumin. The risk that such products will transmit an infectious agent has been reduced by screening plasma donors for prior exposure to certain viruses, by testing for the presence of certain current virus infections, and by inactivating and/or removing certain viruses. Despite these measures, such products can still potentially transmit disease. There is also the possibility that unknown infectious agents may be present in such products. Individuals who receive infusions of blood or plasma products may develop signs and/or symptoms of some viral infections, particularly hepatitis C. ALL infections thought by a physician possibly to have been transmitted by this product should be reported by the physician or other healthcare provider to Grifols Therapeutics LLC [1-800-520-2807].

The physician should discuss the risks and benefits of this product with the patient, before prescribing or administering it to the patient.

Solutions which have been frozen should not be used. Do not use if turbid. Do not begin administration more than 4 hours after the container has been entered. Partially used vials must be discarded. Vials which are cracked or which have been previously entered or damaged should not be used, as this may have allowed the entry of microorganisms. Albumin (Human) 5%, USP (Plasbumin®-5) contains no preservative.

Adverse reactions to albumin are rare. Such reactions may be allergic in nature or be due to high plasma protein levels from excessive albumin administration. Allergic manifestations include urticaria, chills, fever, and changes in respiration, pulse and blood pressure.

Plasbumin-5 should always be administered by intravenous infusion. The choice between the use of Plasbumin-5 and Albumin (Human) 25%, USP (Plasbumin®-25) depends upon whether the patient requires primarily volume (Plasbumin-5) or primarily colloid osmotic activity (Plasbumin-25). Below a serum oncotic level of 20 mm Hg (equal to a total serum protein concentration of 5.2 g per 100 mL) there is evidence which suggests that the risk of complications increases.(1) When the oncotic pressure drops below this level, the patient should be treated with Plasbumin-25 together with diuretics. This is especially important in high risk patients who have undergone abdominal, cardiovascular, thoracic or urologic surgery or who have acute bacteremia.

The volume administered and the speed of administration should be adapted to the response of the individual patient.

A number of factors beyond our control could reduce the efficacy of this product or even result in an ill effect following its use. These include improper storage and handling of the product after it leaves our hands, diagnosis, dosage, method of administration, and biological differences in individual patients. Because of these factors, it is important that this product be stored properly and that the directions be followed carefully during use.

Plasbumin-5 is available in 50 mL, 250 mL, and 500 mL rubber-stoppered vials. Each single dose vial contains albumin in the following approximate amounts:

Store at room temperature not exceeding 30°C (86°F). Do not freeze. Do not use after expiration date.

1. Tullis JL. Albumin. 1. Background and use. 2. Guidelines for clinical use. JAMA. 1977;237:355-60; 460-3.

2. Clowes GHA Jr, Vucinic M, Weidner MG. Circulatory and metabolic alterations associated with survival or death in peritonitis: clinical analysis of 25 cases. Ann Surg. 1966;163(6):866-85.

3. Heyl JT, Janeway CA. The use of human albumin in military medicine. I. The theoretical and experimental basis for its use. US Navy Med Bull. 1942;40:785-91.

4. Janeway CA, Gibson ST, Woodruff LM, Heyl JT Bailey OT, Newhouser LR. Chemical, clinical, and immunological studies on the products of human plasma fractionation. VII. Concentrated human serum albumin. J Clin Invest. 1944;23:465-90.

5. Woodruff LM, Gibson ST. The clinical evaluation of human albumin. US Navy Med Bull. 1942;40:791-6.

6. Janeway CA, Berenberg W, Hutchins G. Indications and uses of blood, blood derivatives and blood substitutes. Med Clin North Am. 1945;29:1069-94.

7. Bennett EJ. Fluid balance in the newborn. Anesthesiology. 1975;43:210-24.

8. Stenland CJ, Lee DC, Brown P, Petteway SR Jr, Rubenstein R. Partitioning of human and sheep forms of the pathogenic prion protein during the purification of therapeutic proteins from human plasma. Transfusion. 2002;42:1497-500.

9. Lee DC, Stenland CJ, Miller JL, Cai K, Ford EK, Gilligan KJ, et al. A direct relationship between the partitioning of the pathogenic prion protein and transmissible spongiform encephalopathy infectivity during the purification of plasma proteins. Transfusion. 2001;41:449-55.

10. Lee DC, Stenland CJ, Hartwell RC, Ford EK, Cai K, Miller JL, et al. Monitoring plasma processing steps with a sensitive Western blot assay for the detection of the prion protein. J Virol Methods. 2000;84:77-89.

11. Cai K, Miller JL, Stenland CJ, Gilligan KJ, Hartwell RC, Terry JC, et al. Solvent-dependent precipitation of prion protein. Biochim Biophys Acta. 2002;1597:28-35.

GRIFOLS

Grifols Therapeutics LLC
Research Triangle Park, NC 27709 USA
U.S. License No. 1871

3060200
(Rev. 8/2020)

NDC 13533-690-20        2.5 g / 50 mL

Albumin (Human)
5%, USP
Plasbumin®-5

5%

Rx only                            50 mL

For Intravenous Infusion Only

GRIFOLS

Heated 60°C 10 hours

This package contains:
2.5 g albumin (human) in 50 mL aqueous
diluent stabilized with 0.004 M sodium
caprylate and 0.004 M acetyltryptophan.
Each 50 mL is osmotically equivalent to
50 mL of plasma.
Approximate sodium content: 145 mEq/L.
Aluminum content: not more than
200 μg/L.

Contains no preservative.

DO NOT USE IF TURBID. DO NOT BEGIN
ADMINISTRATION MORE THAN 4 HOURS
AFTER THE CONTAINER HAS BEEN
ENTERED.

Grifols Therapeutics LLC
Research Triangle Park, NC 27709 USA
U.S. License No. 1871

GRIFOLS

NDC 13533-690-20              2.5 g / 50 mL

Albumin (Human)
5%, USP
Plasbumin®-5

5%

Rx only                            50 mL

For Intravenous Infusion Only

GRIFOLS

The patient and physician should discuss
the risks and benefits of this product.

Dosage and Administration: Read
enclosed package insert.

Single-dose Vial 

Store at room temperature not
exceeding 30°C (86°F). Do not freeze.

If the shrink band is absent or shows any
sign of tampering, do not use the product
and notify Grifols Therapeutics LLC
immediately.

Not returnable for credit or exchange.

GRIFOLS

GTIN 00313533690205
LOT  XXXXXXXXXX
EXP  DDMMMYYYY
SN    XXXXXXXXXXXXXXXX

NDC 13533-690-20          2.5 g / 50 mL

Albumin (Human)
5%, USP

Carton: 3063756

NDC 13533-690-21        2.5 g / 50 mL

Albumin (Human)
5%, USP
Plasbumin®-5

Rx only                                    50 mL

Single-dose Vial
Grifols Therapeutics LLC
Research Triangle Park, NC 27709 USA
U.S. License No. 1871

The patient and physician should discuss the risks and benefits of this
product.
DO NOT USE IF TURBID. DO NOT BEGIN ADMINISTRATION MORE THAN
4 HOURS AFTER THE CONTAINER HAS BEEN ENTERED.
For Intravenous Infusion Only
Contains 2.5 g albumin (human) in 50 mL aqueous diluent stabilized with
0.004 M sodium caprylate and 0.004 M acetyltryptophan. Each 50 mL is
osmotically equivalent to 50 mL of plasma. Approximate sodium content:
145 mEq/L. Aluminum content: not more than 200 μg/L.
Contains no preservative. Any unused portion must be discarded.
Dosage and Administration: Read package insert.
                        
3063752

Lot

Exp.