plasma exchange (TPE), has existed in the United States. Because of this shortage, hospital pharmacists may prepare 5 % solution of human albumin by diluting 25% human albumin with 0.9 % NaCl or, when sodium load is a concern, 5 % dextrose. However, if sterile water alone is used as the diluent, the osmolarity (tonicity) of the albumin solution is reduced and may cause hemolysis in recipients. This report describes two of 10 episodes of hemolysis (one fatal) * among persons who received 25 % human albumin diluted with sterile water and emphasizes that sterile water alone should not be used to dilute albumin. Case 1 In January 1998, a 44-year-old patient in a Maine hospital underwent TPE with 5% human albumin prepared by diluting 25 % human albumin 1:5 with sterile water to treat cryoglobulinemia. After an infusion of 270 mL of the solution, the fluid in the plasma exchange device tubing became tinged red, and the procedure was stopped. The patient reported no symptoms; however, the patient’s hematocrit decreased within 24 hours from 36 % to 29 % (normal: 37%–48%) and 48 hours later, serum creatinin
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