Where does the Albumin go? Human Albumin Solution usage following the implementation of a demand management programme
Human albumin solution (HAS) is widely used in clinical practice for the management of patients with a wide variety of neurological, renal, haematological and metabolic medical conditions (Cochrane Injuries Group Albumin Reviewers, 1998, 2011). It is available in three concentrations, 4.5, 5 and 20%, in the UK (British National Formulary, 2017). The Scottish National Plasma Product Expert Advisory Group developed clinical guidelines for HAS use in 2010, last reviewed in 2016 (Scottish National Blood Transfusion Service, 2016), which outline the majority of indications but lack details of how to manage albumin usage during a shortage. In 2015, the UK faced an acute shortage in the supply of HAS. The increase in demand for HAS worldwide, restrictions on the use of UK‐derived plasma following concerns over possible transmission of new variant of Creutzfelt–Jacob Disease and the higher premium on pricing in other markets has made it harder for the UK to secure significant volumes. In 2015, the number of HAS suppliers for the UK market decreased, and the remaining suppliers initially prioritised their volumes for existing customers. This coupled with manufacturing issues and batch failures increased reliance on even fewer suppliers, creating the perfect storm for an acute supply shortage. Product suppliers allocate volumes for each national market over a 12‐month period, and with the timescale for producing batches of product, it is very difficult to bring more product to the market in a short span of time. In light of the acute shortage, Guy's and St Thomas' NHS Foundation Trust (GSTFT) and Evelina London Children's Hospital (ELCH) introduced a Guideline for the use of HAS and a demand management programme to ensure that usage was restricted to the most appropriate indications and alternatives considered where possible to ensure adequate stock of this finite blood product. Indications were allocated to a colour‐coded category according to evidence available, similar to the Department of Health Immunoglobulin Demand Management Programme (Department of Health, 2011), and for plasma exchange indications, a modified version of the American Society for Apheresis (ASFA) categories were used (Schwartz et al., 2013). This paper describes the demand management programme and audit findings regarding HAS usage at GSTFT and ELCH over a 6‐month period (July to December 2015) following the implementation of the demand management programme.