Pre-set fixed-dose albumin replacement fluid for double filtration plasmapheresis (DFPP) can result in progressive albumin deficit, along with other untargeted protein, leading to loss of osmotic pressure, and subsequently hypotension. This can occur in up to 6% of DFPP procedures. In this study, we aim to determine the serum albumin deficit with fixed-dose replacement regime and estimate the required practical supplementary regime for the discrepancy. We compared the change in serum albumin level among patients treated with DFPP given fixed-dose 10% plasma replacement volume with albumin 5% concentration versus patients given additional replacement with albumin 20% concentration. Seventy-seven DPFF procedures were performed in 16 patients with various neurological disorders. In average, each patient received 4.8 DFPP procedures (Range 3–7) per treatment. Eight patients were given fixed-dose albumin replacement and remaining 8 had additional albumin 20% replacement. Twenty-one (27.3%) procedures had additional replacement. The average change in serum albumin post-DFPP procedures was a reduction of 2.4 g/L (SD 3.0) with fixed-dose replacement and an increment of 0.1 g/L (SD 2.8) for procedures with additional human albumin 20% replacement (p = 0.003). In average, additional 78.6 mL (50–500 mL in up to 5 divided replacements) of albumin 20% replacement given to patients with post-DFPP serum albumin lower than 34 g/L, or in those with post-DFPP negative serum albumin balance depending on severity effectively reduces post-DFPP albumin deficit. In conclusion, fixed-dose albumin replacement for DFPP results in progressive albumin deficits with successive procedures. Addition albumin supplementation may be required.

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