Product: lyophilized hematin (Panhematin). A different formulation (hematin arginate) is available outside the USA.
Requirements:
(1) 313 mg vial of lyophilized hematin
(2) 150 mL sterile glass bottle
(3) 3 bottles of 25% albumin each 50 mL
(4) large syringe with a 5 micron filter needle
(5) vent needle
(6) amber bag (to protect the prepared mixture from the light)
(7) large syringe
Dose required: from 3 to 4 mg/kg per dose up to a maximum of 313 mg (1 vial), not to exceed 6 mg/kg per 24 hours.
Duration of therapy: usually 4 days
Concerns:
(1) The solution must be protected from oxygen and light to minimize degradation.
(2) The mixture has a limited stability once prepared (about 1 hour).
(3) The mixture needs to be infusee into a large peripheral vein to reduce the risk of thrombophlebitis.
(4) A transient coagulopathy may occur which but is less likely if 25% albumin is used instead of normal saline to prepare the mixture.
(5) For many situations the ideal body weight may reflect blood volume better than the actual body weight. The limit (313 mg) placed on a dose may allow actual body weight to be used.
Solution preparation:
(1) Place a vent needle into the hematin vial.
(2) Inject 132 mL (2.64 bottles) of 25% albumin into the 313 mg vial of hematin using a separate needle.
(2) Swirl but do not shake to mix. The solution will be a dark color.
(3) The solution will have a hematin concentration of 2.4 mg/mL.
(4) Withdraw the required volume into the syringe through the 5 micron needle filter.
(5) Inject the hematin-albumin solution into the 150 mL bottle.
(6) Label the bottle. Place in the amber bag to protect the mixture from light.
(7) Ship to the floor and infuse STAT.
(8) Infuse normal saline through the infusion line for 10 minutes after the infusion.
volume of hematin-albumin solution to infuse in mL =
= MIN(313,(dose in mg/kg)*(body weight in kilograms)) / 2.4
