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RoundsHuman serum albumin has been in clinical use for more than 60 years, since World War II. The Cohn fractionation process was instrumental in bringing about albumin availability to the battlefield and the hospital. The clinical role of albumin has been debated over time and has changed; however, the substance is still widely used despite reservations about its usefulness in certain contexts. The overall safety profile of human albumin has been excellent; nevertheless, some individuals experience an allergic reaction against infused albumin that can result in anaphylaxis.¹ Case SummaryThe patient is a 74-year-old man with a history of gingival recurrent squamous cell carcinoma who was undergoing neck dissection to treat his lymph nodes. He was given 500 mL of 5% human albumin (Octapharma) but did not receive any other blood products. After administration of albumin, he suddenly developed intractable hypotension (Table 1). Also, once the surgical drapes were removed, the patient exhibited a rash and flushing on his chest and abdomen. He was treated with 30 μg of epinephrine and 10 U of vasopressin; the attending anesthesiologist recorded his severe reaction to albumin in the allergy-alert section of his medical record. This complication resulted in the cessation of the surgical procedure, which had to be rescheduled to a later time, once the condition of the patient had become stable again. ResolutionA specimen from the patient was sent for immunoglobulin A (IgA) testing to rule out an anaphylactic IgA-deficiency reaction; the results were normal. The medical records for ABSTRACT Reactions to human albumin are rare, but happen at a frequency to warrant caution since it is routinely produced from batched human plasma. Albumin preparations have advanced substantially in purity since their inception, but despite this achievement severe reactions may still occur. These reactions may include a rash, urticarial, hypotension, dyspnea, or even anaphylaxis. The patient is a 74 year old male with history of recurrent squamous cell carcinoma of gingiva undergoing a neck dissection for lymph nodes. The patient was given 500 mL of albumin and suddenly developed intractable hypotension. In addition, once the surgical drapes were removed, the patient exhibited a rash and flushing on both the chest and abdomen. The patient was treated with pressor agents and a severe reaction to albumin was logged in the allergy alert section of the patient chart. Although human albumin has an excellent safety profile, it is important to recognize allergic transfusion reaction symptoms quickly and initiate an appropriate investigation.

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