The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: A systematic review

Abstract

Apheresis effectively reduces serum TG levels. However, due to uncontrolled data, reporting bias and lack of a comparison group, definitive conclusions on the efficacy of apheresis in reducing AP severity cannot be made. We propose which patients may be best suitable for apheresis, type of studies needed and outcome measures to be studied in order to provide empiric data on the role of apheresis in HTG-related AP.

Acute pancreatitis in adults and children

“…Hypertriglyceridaemia was an etiological factor of AP in our cohort, as described for other cohorts (77)(78)(79)(80). However, it is always a question whether elevation of serum triglyceride level is the cause of AP or merely a consequence of alcohol consumption and/or the hypertriglyceridaemia is just a coincidence.…”

Severe Hypertriglyceridemia-Induced Pancreatitis in Young Female Managed with Plasmapharesis: A Case Report

“…However, with heparin the effect on triglyceride reductions is transient and the patient experience re-accumulation of TGS with long term infusion [10,11], on the other hand insulin use in non-diabetics has no clear evidence [11]. Patients with HTG-AP are more susceptible to systemic inflammatory response syndrome and end organ damage than in other types of pancreatitis [8] making therapeutic plasma exchange most beneficial to reduce serum triglyceride levels, as it was proposed that its efficacy is superior especially when there is evidence of shock or end-organ failure due to systemic inflammatory response syndrome [5]. In our case report the young patient presented with severe form of hyperlipedemic pancreatitis in the acute phase with triglyceride levels at first of (1335 mg/dL), management with a trial of hypolipidemics was unsatisfactory and only Plasma exchange lowered the lipid level and TGs with a value reaching (934 mg/dl) after the first session and also improved the clinical status of the patient.…”

“…A positive family history of signs and symptoms of hypertriglyceridemia is necessary to steer the diagnosis. Current guidelines of management must include full dose hypolipidemic mainly fibrates, minimization of dietary fat consumption, insulin and/or heparin, administration of plasmapheresis and/or lipid pheresis have be found to be the most useful in reduction of TG levels, improving of clinical signs and symptoms during the active phase of pancreatitis also effectively preventing further episodes of pancreatitis [4,5]. In this case report a female patient with positive family history for hyperlipedemia, no past significant history of diabetes or history of alcoholism or gall stones or significant drug history, was diagnosed with hyperlipidemia induced pancreatitis and received one session of hemodialysis then plasmapharesis was initiated and she received 8 sessions with full dose of hypolipidemics.…”

Hypertriglyceridemia–induced acute pancreatitis: a systematic review of the literature

“…In the subgroup of patients with triglycerides > 5 000 mg/dL, the plasmapheresis decreased the hospitalization from 11 to 5 days (P = 0.012) [37]. Click et al reviewed 74 articles with 301 patients addressing the role of apheresis in hypertriglyceridemic acute pancreatitis [38]. Seventy percent of patients received the procedures within the first 48 h, and almost 85% required one-two sessions.…”