Aluminum toxicity and albumin

Area of Science:

• Neonatal intensive care
• Biomedical engineering
• Clinical chemistry

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates with critical cardiorespiratory failure.
• Priming solutions are essential for ECMO procedures, and their composition must be carefully controlled.
• Elevated aluminum (Al) levels in medical solutions can pose toxicity risks, particularly in vulnerable populations.

Purpose of the Study:

• To investigate the source of unexpectedly high aluminum levels detected in ECMO priming solutions.
• To evaluate the aluminum content of different albumin brands and blood products used in neonatal ECMO.
• To identify potential contamination sources within the ECMO circuit, such as heat exchangers.

Main Methods:

• Analysis of aluminum concentrations in ECMO priming solutions prepared with various 25% albumin brands.
• Comparison of aluminum levels between different albumin concentrations (5% and 25%) and blood products.
• Assessment of aluminum leaching from ECMO heat exchangers by comparing fluid perfusate with stainless steel alternatives.

Main Results:

• Certain brands of 25% albumin were identified as containing aluminum within the toxic range.
• A significant reduction in priming solution aluminum was observed after switching to a lower-aluminum content albumin brand.
• No elevated aluminum levels were found in fluids passing through the heat exchanger, ruling it out as a primary source.

Conclusions:

• The primary source of toxic aluminum levels in the studied ECMO priming solutions was attributed to specific brands of 25% albumin.
• Careful selection of albumin products with low aluminum content is crucial for neonatal ECMO safety.
• Further investigation into albumin manufacturing processes may be warranted to minimize aluminum contamination.