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Reconstitution of Hematin for Intravenous Infusion
- Karl E. Anderson, MD;
- Herbert L. Bonkovsky, MD;
- Joseph R. Bloomer, MD; and
- Steven I. Shedlofsky, MD
- From University of Texas Medical Branch, Galveston, TX 77555-1109; University of Connecticut Health Center, Farmington, CT 06030; University of Alabama at Birmingham, Birmingham, AL 35294; and University of Kentucky, Lexington, KY 40506.
TO THE EDITOR:
Background: Hemin, the preferred treatment for acute porphyrias (1), is available in the United States as lyophilized hematin (Panhematin, Ovation Pharmaceuticals, Deerfield, Illinois) and is reconstituted with sterile water just before infusion. The product package insert recommends that treatment be administered through a large arm vein or by central venous catheter to avoid phlebitis.
Many physicians and medical centers have adopted the published method of Bonkovsky and colleagues (2) for reconstituting hematin with 25% human albumin. Each albumin molecule has a single high-affinity heme binding site and additional lower affinity sites. This reconstitution method uses an equimolar amount of albumin to optimize the stability of hemin as heme albumin and to prevent formation of degradation products that lead to unwanted side effects, including phlebitis at the site of intravenous infusion and transient coagulopathy. Many health care providers have requested detailed instructions for this method of reconstituting lyophilized hematin with albumin.
Objective: To facilitate optimal treatment by providing a detailed description of the method that the authors have used for reconstituting hematin with albumin and for administering the product as heme albumin.
Methods: A stable hemin solution is prepared by reconstituting lyophilized hematin with 132 mL of 25% human serum albumin instead of sterile water. It is important not to add sterile water before the albumin because this will immediately lead to degradation products. …
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