Inadvertent Aluminum Administration during Plasma Exchange Due to Aluminum Contamination of Albumin-Replacement Solutions

ALUMINUM can accumulate in patients with reduced renal function due to impaired excretion of aluminum^1,2 and in patients with normal renal function who receive large parenteral amounts of aluminum.³ Manifestations of aluminum toxicity include vitamin D–refractory osteodystrophy, hypercalcemia, anemia, and severe progressive encephalopathy.^{4 5 6} Aluminum-related osteodystrophy is characterized by increased bone aluminum content, with aluminum deposits along the mineralization front, impaired mineralization, and a reduced rate of bone formation.⁷ Clinical correlates of the bone abnormalities include bone pain, proximal myopathy, and in some patients pathologic fractures.⁸ Aluminum-related encephalopathy is frequently fatal.⁹ Recognized sources of aluminum include water used for dialysis, solutions.