Plasmapheresis as treatment for patients with severe hypertriglyceridemia

Severe hypertriglyceridemia (SHGT) occurs when triglyceride values exceed 1,000 mg/dl which places patients at considerable risk of acute pancreatitis. Treatment of SHGT includes lipid lowering approches and dietary interventions. Insulin infusion is considered to decrease triglyceride levels in patients who display SHTG related acute pancreatitis. Plasmapheresis is an effective method and an extracorporeal process which may be used both in urgent and in selective cases. Plasma exchange and double cascade filtration are methods of plasmapheresis used in SHTG and possible following acute pancreatitis. In this article effect and mechanisms of plasmapheresis on SHTG and related acute pancreatitis will be discussed.

PDF

___

1. Cleeman JI. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). J Am Med Association. 2001;285:2486– 97.

2. Scherer J, Singh VP, Pitchumoni CS et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol. 2014;48:195-203.

3. Gofman J, Strisower B, deLalla O, et al. Index of coronary artery atherogenesis. Mod Med. 1953;21:119-40.

4. Sarwar N, Danesh J, Eiriksdottir G et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies.. Circulation. 2007;115:450-8.

5. Simpson HC, Mann JI, Meade TWet al.Hypertriglyceridaemia and hypercoagulability. Lancet. 1983;1:786-90.

6. Deng LH, Xue P, Xia Q et al. Effect of admission hypertriglyceridemia on the episodes of severe pancreatitis. World Gastroenterol. 2008;14:4558–61.

7. Whitcomb DC. Clinical practice Acute pancreatitis. N Engl JMed. 2006;354:2142–50.

8. Fredrickson DS. An international classification of hyperlipidemias and hyperlipoproteinemias. Ann Intern Med. 1971;75:471–2.

9. Sadr-Azodi O, Orsini N, Andren-Sandberg A et al. Abdominal and total adiposity and the risk of acute pancreatitis: a population-based prospective cohort study. Am J Gastroenterol. 2013;108:133-9.

10. Mikhail N, Trivedi K, Page C et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin. Am J Emerg Med. 2005;23:415–7.

11. Näsström B, Olivecrona G, Olivecrona T, et al. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med. 2001;138:206–13.

12. Betteridge DJ, Bakowski M, Taylor KG et al. Treatment of severe diabetic hypertriglyceridemia by plasma exchange. Lancet. 1978;1:1368.

13. Winters JL. American society for apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner. J Clin Apher. 2014;29:191-3.

14. Navina S, Acharya C, DeLany JP et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med. 2011;3:107-10.

15. Yeh JH, ChenJH, ChiuHC. Plasmapheresis forhyperlipidemic pancreatitis, J Clin Apheresis. 2003;18:181–5.

16. Yeh JH, Lee MF, Chiu HC. Plasmapheresis for Severe Lipemia: Comparison of Serum-Lipid Clearance Rates for the Plasma-Exchange and Double-Filtration Variants. J Clinl Apheresis. 2003;18:32–6.

17. Stefanutti C, Di Giacomo S, Vivenzio Aet al. Therapeutic plasma exchange in patients with severe hypertriglyceridemia: a multicenter study. Artif Organs. 2009;33):1096–102

18. Ewald N, Kloer HU. Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis. Clin Res Cardiol Suppl. 2012;31:2.

19. Giannini G, Valbonesi M, Morelli F et al. Hypertriglyceridemia: apheretic treatment. Int J Artif Organs. 2005;28:1018–24

20. Antonic M, Gubensek J, Buturovic-Ponikvar J et al. Comparison of citrate anticoagulation during plasma exchange with different replacement solutions.Ther Apher Dial. 2009;13:322-6.

21. Gubensek J, Buturovic-Ponikvar J, Romozi K et al.Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One. 2014;9:e102748

22. ZeitlerH, Balta Z, Klein B et al. Plasmapheresis for hypertriglycerdemia-induced pancreatitis. Ther Apher Dial. 2015;19:405-10.23.

23.Gubensek J, Buturovic –Ponikvar J, Marn –Pernat B et al. Treatment of hyperlipidemic acute pancreatits with plasma exchange: a single centre experience. Ther Apher Dial. 2009;13:314–7.

24. Watts GF, Mitropoulos KA, al-Bahrani A et al. Lecithin –cholesterol acyltransferase deficiency presenting with acute pancreatitis: effect of infusion of normal plasma on triglyceride rich lipoproteins. J Intern Med. 1995;238:137–41

25. Bramlage CP, Schröder K, Bramlage P, et al. Predictors of complications in therapeutic plasma exchange. J Clin Apher. 2009;24:225-31.

26. Costantini N, Mameli A, Marongiu F. Plasmapheresis for Preventing Complication of Hypertriglyceridemia: A Case Report and Review of Literature. Am J Ther. 2016;23:288-91.

27. Nakanichi T, Suzuki N, Kuragano T et al. Current topics in therapeutic plasmapheresis. Clin Exp Nephrol. 2014;18:41–9.

28. Piolot A, Nadler F, Cavallero E et al. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas. 1996;13:96–99.

29. Galan Carrillo, Demelo-Rodriguez P, Rodríguez Ferrero ML et al. Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia. J Clin Lipidol. 2015;9:698-702.

30. Chang CT, Tsai TY, Liao HY et al. Double filtration plasma apheresis shortens hospital admission duration of patients with severe hypertriglyceridemia-associated acute pancreatitis. Pancreas. 2016;45:606-12.

31. Toskes PP. Hyperlipidemic pancreatitis. Gastroenterol Clin North Am. 1990;19:783–91.

32. Zborovszky EC, Santana-Cabrera L, Ramírez Rodríguez A et al. Plasmapheresis in the treatment of an acute pancreatitis due to hypertriglyceridemia. Med Clinica. 2014;142:282.