Title: Use of Plasmapheresis in hypertriglyceridemia-induced acute recurrent pancreatitis: a challenging experience
Authors: Hussain A. Jahlan, Esraa M. Hasan, Hanan H. Almalki, Eman A. Almhjani, Wejdan A. Mobasher
DOI: https://dx.doi.org/10.18535/jmscr/v8i4.91
Abstract
Background: Hypertriglyceridemia is a well-established but underestimated cause of acute and recurrent pancreatitis. Initial management of patients with Hypertriglyceridemia-induced pancreatitis includes treatment of acute pancreatitis and reduction of serum triglyceride levels to <500 mg/dL by administering intravenous insulin and plasmapheresis in selected patients with severe HTGP. Patients with HTGP require long-term therapy consists of both pharmacologic therapy and dietary fat restriction.
Aim: To affirm the use of plasmapheresis in treatment and prevention of acute recurrent hypertriglyceridemic pancreatitis.
Case: A 35-year-old female with familial hypertriglyceridemia resistant to medical therapy and a history of recurrent attacks of hypertriglyceridemic pancreatitis presented with acute pancreatitis and TG level of 1414 mg\dl. The patient was admitted and underwent repeated sessions of plasmapheresis along with medical therapy which resulted in a significant reduction of TG and a complete resolution of her pancreatitis symptoms.
Keywords: Hypertriglyceridemia, Hyperlipidemia, Acute pancreatitis, Plasmapheresis.
References
- Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am. 1990;19:783–91.
- Seales CE, Ooi TC. Underrecognition of chylomicronemia as a cause of acute pancreatitis. CMAJ. 1992;147:1806–8.
- Yadav, Dhiraj, and C. S. Pitchumoni. "Issues in hyperlipidemic pancreatitis." Journal of clinical gastroenterology 36.1 (2003): 54-62.
- Hegele RA. Monogenic dyslipidemias: Window on determinants of plasma lipoprotein metabolism. Am J Hum Genet. 2001;69:1161–77.
- Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, Stalenhoef AF. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2012 Sep 1; 97(9):2969-89.
- Scherer J, Singh V, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis-an update. Journal of clinical gastroenterology. 2014 Mar; 48(3):195.
- Fredrickson DS. An international classification of hyperlipidemias and hyperlipoproteinemias. Annals of internal medicine. 1971 Sep 1; 75(3):471-2.
- Linares CL, Pelletier AL, Czernichow S, Vergnaud AC, Bonnefont-Rousselot D, Levy P, Ruszniewski P, Bruckert E. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia. Pancreas. 2008 Jul 1; 37(1):13-2.
- Saharia P, Margolis S, Zuidema GD, Cameron JL. Acute pancreatitis with hyperlipemia: studies with an isolated perfused canine pancreas. Surgery. 1977;82:60–67.
- Nawaz, Haq, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis. American Journal of Gastroenterology 110.10 (2015): 1497-1503.
- Nayak, Keshav R., and Richard G. Daly. "Eruptive xanthomas associated with hypertriglyceridemia and new-onset diabetes mellitus." New England Journal of Medicine 350.12 (2004): 1235-1235.
- Howard JM, Reed J. Pseudohyponatremia in acute hyperlipemic pancreatitis. A potential pitfall in therapy. Arch Surg 1985; 120:1053.
- Tamez-Pérez HE, Sáenz-Gallegos R, Hernández-Rodríguez K, et al. [Insulin therapy in patients with severe hypertriglyceridemia]. Rev Med Inst Mex Seguro Soc 2006; 44:235.
- Henzen C, Röck M, Schnieper C, Heer K. [Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis]. Schweiz Med Wochenschr 1999; 129:1242.
- Connelly-Smith L, Dunbar NM. The 2019 guidelines from the American Society for Apheresis: what's new? CurrOpinHematol 2019; 26:461.
- Gubensek J, Buturovic-Ponikvar J, Romozi K, Ponikvar R. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One 2014; 9:e102748.
- Gavva C, Sarode R, Agrawal D, Burner J. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: A rapid and practical approach. TransfusApher Sci 2016; 54:99.
- Piolot A, Nadler F, Cavallero E, et al. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas 1996; 13:96.
- Kyriakidis AV, Raitsiou B, Sakagianni A, Harisopoulou V, Pyrgioti M, et al. (2006) Management of acute severe hyperlipidemic pancreatitis. Digestion 73: 259–64.
- Joglekar K, Brannick B, Kadaria D, Sodhi A. Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis: case series and review of the literature. Therapeutic advances in endocrinology and metabolism. 2017 Apr; 8(4):59-65.
- Preiss D, Tikkanen MJ, Welsh P, et al. Lipid-modifying therapies and risk of pancreatitis: a meta-analysis. JAMA 2012; 308:804.