As mentioned in the earlier discussion about plasma, 5% albumin can be used instead of plasma to restore colloid oncotic pressure, mainly in hypovolemic shock due to massive acute blood loss or extensive burns. About 40% of body albumin is intravascular, with the remainder being in extracellular fluid. In a normal-sized person, 500 ml of blood contains about 11 gm of albumin, which is about 3.5% of total body albumin and about 70% of the albumin synthesized daily by the liver. Therefore, the albumin lost in three or four units of whole blood would be replaced in about 3 days of normal production. The AABB and other investigators believe that albumin has been overused in bleeding persons. They discourage use of albumin infusions in persons with hypoalbuminemia due to chronic liver disease or albumin loss through the kidneys or gastrointestinal tract on the grounds that such therapy does not alter the underlying disease and has only a very short-term effect. They are also critical of therapeutic albumin in hypoalbuminemia due to nutritional deficiency, which should be treated with parenteral hyperalimentation or other nutritional therapy. Purified plasma protein fraction (PPPF) can be used in most cases instead of albumin but has few advantages. It is not recommended when rapid infusion or large PPPF volumes are needed since it may have a hypotensive effect under these conditions. Albumin and PPPF do not transmit viral hepatitis because they are pasteurized.