As an alternative, some TPE procedures can be completed by 5% albumin as the replacement fluid; however, critically ill COVID-19 patients have a high incidence of coagulopathy and TPE procedures with the use of albumin may result in depletion of procoagulant factors and increased bleeding risk.18,47,77,78 The time required for these factors to regain their original concentrations varies and can take up to 18 days, depending on the substance.47,78 This may necessitate the use of plasma as the replacement fluid. Here, ALB is linked to blood coagulation disease.