【Abstract】Objective: To investigate the safety of albumin combined with acetate Ringer's solution in therapeutic plasma exchange(TPE) of pediatrics. Methods: A total of 20 patients with diseases requiring TPE from April 2017 to March 2023 in the intensive care unit of Children’s Hospital of Nanjing Medical University were included, and were randomly divided into observation group and control group. The observation group chose 20% albumin combined with acetate Ringer's solution in the ratio of 1:5 as the replacement fluid, and the control group chose fresh frozen plasma as the replacement fluid for TPE. The hemodynamic indexes and the occurrence of complications during treatment and the coagulation indexes、biochemical indexes and the response of the underlying disease 1 week after the end of treatment between the 2 groups of patients were compared. The coagulation indexes and biochemical indexes were compared within groups before and after TPE. Results: Mean arterial pressure and heart rate were stable in both groups during treatment and the difference was not statistically significant (P＞0.05); Total protein (TP), globulin (GLB), fibrinogen (Fbg), serum phosphorus (P), and serum calcium (Ca2+) decreased in the observation group compared with those before treatment, and the difference was statistically significant (P < 0.05). Albumin (ALB), international normalized ratio (INR), prothrombin time (PT), P, Ca2+, and serum magnesium (Mg2+) decreased in the control group compared with those before treatment. The incidence of allergic metaplasia and hypocalcemia between the two groups after treatment were not statistically significant (P>0.05). The coagulation indexes、biochemical indexes and the response of the underlying disease 1 week after the end of treatment between groups were not statistically significant (P>0.05). Conclusion: It is safe to apply 20% albumin combined with acetate Ringer's solution (1:5) as replacement fluid in TPE of pediatric and can effectively save blood resources, but the coagulation and biochemical indexes need to be monitored during the treatment, and blood products such as fresh frozen plasma should be supplemented promptly to correct coagulation function.