Plasma albumin repletion after transfusion with polymerized hemoglobin

Pyridoxalated polymerized hemoglobin (PPHG) has promise as a blood substitute for transfusing patients with hemorrhage. Exchange transfusion with PPHG depletes plasma proteins. The purpose of this study was to determine if, during the early repletion of intravascular proteins, albumin was transported from the interstitium of skin or skeletal muscle into the vascular compartment. PPHG was prepared from stroma-free human hemoglobin (100-120 mg/ml). The Hct of anesthetized rats dropped from 42 +/- 4% to 10 +/- 1% after exchange transfusion. Immediately postexchange plasma albumin declined from 24 +/- 2 to 6 +/- 3 mg/ml. Five hours postexchange transfusion plasma albumin had doubled and the skin and skeletal muscle albumin content was 80% of control. These data indicate that a shift of interstitial albumin from skin and skeletal muscle can rapidly replace plasma protein deficits after massive transfusion with PPHG.