Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia

Abstract

Rationale:Severe hypertriglyceridemia is the 3rd-leading cause of acute pancreatitis. Current treatment option for hypertriglyceridemia associated with acute pancreatitis is mainly supportive measures, including adequate fluid supply, pain management, and broad-spectrum antibiotics if necessary. Extracorporeal method by mean of plasmapheresis is effective in reducing serum level of triglyceride. It has been proposed to have therapeutic potential in limited small sample studies.Patient concerns:A retrospective review of therapeutic effect of double filtration plasmapheresis in treating hypertriglyceridemia associated with acute pancreatitis was conducted by enlisting 3 patients who meet the criteria for the present study.Diagnoses:Three patients met the criteria for hypertriglyceridemia (serum level >800 mg/dL) associated with acute pancreatitis (either with elevated serum level of lipase and/or amylase and/or with computed tomography evidence of acute pancreatitis).Interventions:Patients received double filtration plasmapheresis.Outcomes:We found that an effective reduction of triglyceride was achieved on an average of 84.7% as a result of a single session of plasmapheresis. All 3 of our patients survived, but needed extended hospitalization.Lessons:A substantial clinical trial is required to further assess the effectiveness of plasmapheresis in managing of acute pancreatitis in the setting of hypertriglyceridemia.

The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis

“…The DFPP treatment quickly removes TG‐rich lipoproteins, which theoretically reduces the accumulation of toxic free fatty acid metabolites of TGs and the hyperviscosity caused by chylomicrons. However, a clear benefit of DFPP in reducing the severity and improving outcomes in HTGP has not been conclusively shown 13,26 . In our study, we found that early initiation of DFPP treatment seemed to have no obvious influence on patients’ clinical outcomes.…”

“…American Society for Apheresis classes HTGP as a category III indication (the individualized decision is necessary) 12 . To date, the experience of DFPP in HTGP patients is quite limited and mainly based on case reports and small case series 13 . Therefore, we performed this retrospective observational study of HTGP using propensity score matching.…”

Plasmapheresis Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis: A Case Report

“…Hypertriglyceridemia is the third most common cause of AP, after gallstones and alcohol, and the causative factor in about 9% of patients [1,3]. It is usually seen in patients whose TG levels exceed 1000 mg/dL [3].…”

“…Hypertriglyceridemia is the third most common cause of AP, after gallstones and alcohol, and the causative factor in about 9% of patients [1,3]. It is usually seen in patients whose TG levels exceed 1000 mg/dL [3]. Studies estimate that one in five patients with severe hypertriglyceridemia will experience at least one episode of acute pancreatitis [4].…”

“…There is no clear evidence as to which hypertriglyceridemic patients will develop AP and as to whether they are at increased risk for chronic disease [2]. For the most part, the management of HTG-AP consists of supportive measures such as fluid resuscitation, pain control and, if indicated, antibiotics [3]. In HTG-AP, plasmapheresis has proven beneficial in reducing the level of triglycerides (TG), although there is no clearly established evidence for its benefits in decreasing mortality [1].…”