Therapeutic Plasmapheresis: A Treatment Modality in Severe Hypertriglyceridemia in Adolescence (original) (raw)
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Background: Hyperlipidemic pancreatitis (HP) is caused by severe hypertriglyceridemia (SHTG). Evidence of SHTG refractoriness to standard medical treatment but not to therapeutic apheresis has increased in the last years. Methods: Described is the timing of clinical events and the sequence of therapeutic plasma-exchange (TPE) procedures to treat pancreatitis due to SHTG in a male patient, Caucasian, aged 49 years, referred to emergency for severe epigastric pain. There was no history of alcohol consumption, a pre-existing mild hyperlipidemia was treated with diet alone, and biliary imaging was normal. Physical examination revealed epigastric tenderness. Laboratory investigation revealed marked hypertriglyceridemia (11,355 mg/dL; range: 30–150), and hypercholesterolemia (941 mg/dL; range: 80–200). Serum amylase (Amy) and lipase (Lip) were increased: 160 UI/L (range: 20–100) and 175 UI/L (range: 13–60), respectively. A computerized tomography (CT) scan of the abdomen revealed a picture compatible with acute pancreatic phlogosis. It was diagnosed as ''acute secondary pancreatitis (AP) and SHTG''. Results: The patient was successfully submitted to three sessions of TPE in emergency. He was released from hospital after 13 days of hospitalization. The levels of lipids and lipopro-teins in his plasma were as follows: triglycerides (TG) 185 mg/dL; total cholesterol (TC) 179 mg/dL; HDL-cholesterol (HDLC) 22 mg/dL; LDL-cholesterol (LDLC) 120 mg/dL. Conclusions: The decision to submit the patient with clinical evidence of HP caused by SHTG to apheresis was correct. The improvement in the clinical picture was fast and the recovery was complete.
Journal of Renal and Hepatic Disorders, 2017
Acute pancreatitis is a potentially life-threatening disease. If the diagnosis and the treatment are not prompt, it can rapidly evolve to a medical emergency. Severe hypertriglyceridemia, defined as above 1000 mg/dl, is the third most common cause of acute pancreatitis. Conventional management includes fat dietary restriction and pharmacological treatment; however, these measures take time to be effective. Plasmapheresis seems to be an alternative and safe adjunctive therapy because it allows the rapid reduction of the trigger agent in circulation. Its use, especially in severe cases, has been increasingly reported. The authors report three cases of severe hypertriglyceridemia-induced pancreatitis in which early plasmapheresis was successfully used with other supportive clinical management.
Plasmapheresis in the Treatment of Hypertriglyceridemic Pancreatitis with ARDS
Digestive Diseases and Sciences, 2006
Hypertriglyceridemia is a form of dyslipidemia that can lead to the development of pancreatitis. In this form of pancreatitis the serum pancreatic enzymes may be normal or mildly elevated. In addition to the regular treatment of pancreatitis of any etiology, plasmapheresis has been shown to improve the symptoms, laboratory findings, and outcome of hypertriglyceridemic pancreatitis (HTGP). We report a case of acute pancreatitis caused by hypertriglyceridemia, which was successfully treated with plasmapheresis. In addition to the improvement in the patient's pancreatitis, we noticed a prompt resolution of adult respiratory distress syndrome (ARDS) with the plasmapheresis. We suggest that this treatment modality may play a therapeutic role in patients with pancreatitis-induced ARDS.
Pancreatic Disorders & Therapy, 2018
Objectives: Plasmapheresis has been repetitively reported as an effective treatment in hypertriglyceridemiainduced acute pancreatitis (HTG-AP). However, due to heterogeneity in presenting severity, different definition of clinical end-points and lack of well-matched control group, a definitive role of plasmapheresis is yet to be determined. Methods: We reviewed a cohort of 142 unique patients of HTG-AP, in which 15 cases were treated with plasmapheresis. We compared the epidemiologic characteristics, presenting clinical severity and various clinical end-points between plasmapheresis group and non-plasmapheresis group directly and after successful propensity score match. The clinical trajectory of plasmapheresis group and post-match nonplasmapheresis group were plotted and compared. Results: Patients who underwent plasmapheresis had higher triglyceride levels on admission, and had a trend toward more severe pancreatitis. The unmatched cohort revealed that plasmapheresis group had longer hospital stay, required more intravenous insulin, and had longer duration of nil per os. However post-match comparison revealed that plasmapheresis had no effect on clinical outcomes. Despite the successful match of epidemiologic characteristics and presenting clinical severity, plasmapheresis group was responding slower than post-match nonplasmapheresis group, which suggests the existence of unmeasured confounding factors and possibility of obscured benefit given the similarities in various end-points. Conclusions: Although plasmapheresis had no apparent benefit or harm, there likely was residual confounding based on the different clinical trajectories between the plasmapheresis and non-plasmapheresis groups. Randomized controlled trial, or a larger multicentre observational study taking into consideration the clinical trajectory is needed to further evaluate the role of plasmapheresis in HTG-AP.
Acute pancreatitis due to hypertriglyceridemia: Plasmapheresis versus medical treatment
Turkish journal of emergency medicine, 2023
OBJECTIVE: Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG. METHODS: This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded. RESULTS: Forty-seven patients were included in the study. The level of triglyceride decreases at the 24 th h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (P = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703-0.940]; P < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cutoff value of triglyceride was accepted as 3079.5 mg/dL. CONCLUSION: Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.
Plasmapheresis in hypertriglyceridemia-related pancreatitis: a case report
Emergency Care Journal, 2012
Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP), accounting for up to 7% of cases. The clinical manifestations are similar to those of AP from other causes, but it may be difficult to recognize because of confounding laboratory investigations induced by HTG, such as a falsely normal serum amylase. Prompt recognition is important to provide adequate treatment. The maintenance of blood triglyceride (TG) levels below 500 mg/dl has been shown to accelerate the clinical improvement in patients with hypertriglyceridemic pancreatitis (HTGP). In many cases series apheresis was effective in reducing HTG and an early initiation is likely to be beneficial in order to prevent recurrence of AP and the development of necrotizing pancreatitis. Definitive guidelines for the treatment of HTGP and randomized trials that compare the effectiveness of apheresis with the medical therapy alone are still lacking.
Clinical Characteristics and Sequelae of Severe Hypertriglyceridemia in Pediatrics
Endocrine Practice, 2018
Objective: Severe hypertriglyceridemia (HTG) (i.e., plasma triglycerides [TGs] >1,000 mg/dL) in children is a rare but pernicious and understudied condition. Our objective was to evaluate the etiology, characteristics, and sequelae of severe pediatric HTG. Methods: This was a retrospective electronic medical record review of pediatric patients with severe HTG at a tertiary referral Children's hospital over a 17-year period. Results: There were a total of 124 patients with severe HTG. The etiology varied: hemato-oncologic (n = 48), diabetes and insulin resistance-related (n = 46), total parenteral nutrition (TPN)-related (n = 6), renal (n = 12), and miscellaneous (n = 12). There was considerable variability in the number of days for the plasma TGs to decrease to <1,000 mg/dL (147.7 ± 567.3 days) and to further decrease to <500 mg/dL (136.84 ± 230.9 days). Patients with diabetes required the longest time to improve their plasma TGs (165.8 ± 305.7 days) compared to other groups. There were 11 cases of pancreatitis, comorbid with diabetes (n = 5), hematooncologic conditions (n = 3), and TPN (n = 3). Sixty-seven patients (54%) had persistent HTG. Conclusion: Severe HTG in pediatrics is commonly due to secondary causes. Patients with diabetes tend to have a longer course of dyslipidemia. A substantial number of patients had persistent dyslipidemia, indicating underlying genetic susceptibility to HTG that is phenotypically expressed consequent to a secondary metabolic insult. (Endocr Pract. 2018;24:xxx-xxx) Abbreviations: DKA = diabetic ketoacidosis; EMR = electronic medical record; GSD = glycogen storage disorder; HbA1c = hemoglobin A1c; HIV = human immunodeficiency virus; HTG = hypertriglyceridemia; ICD-9 = International Classification of Diseases-Ninth Revision; IV = intravenous; LPL = lipoprotein lipase; LCHAD = long chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency; NPO = nothing by mouth; PCOS = polycystic ovary syndrome; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TG = triglyceride; TPN = total parenteral nutrition; VLDL = very-low-density lipoprotein
Plasmapheresis in the Management of Severe Hypertriglyceridemia
Critical Care Nurse, 2013
Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia. The lipemia-associated interference in laboratory studies made treatment of electrolyte abnormalities extremely difficult. The hypertriglyceridemia was initially treated with insulin, antilipidemic medications, and heparin, but the levels of triglycerides remained elevated, delaying results of needed laboratory studies for hours. After plasmapheresis, the serum level of triglycerides decreased by 77% in less than 24 hours. Severe lipemia interferes with photometric laboratory studies, yielding an underestimation of serum levels of electrolytes. Plasmapheresis is safe, rapid, and effective for emergent management of severe hypertriglyceride...