The patient’s serum albumin on the day before surgery was 44.8 g/L, within the normal range.[2] However, the intraoperative albumin concentration dropped significantly to 13.5 g/L, coupled with critical circulatory instability and an immediate need for resuscitation, meeting criteria for grade 4 hypoalbuminemia.[2] We identified several contributing factors: substantial protein loss through exudative ascites. The gene discussed is ALB; the disease is Hypoalbuminemia.