Therapeutic Plasma Exchange in Patients With Severe Hypertriglyceridemia: A Multicenter Study

Stefanutti, Claudia; Giacomo, S. Di; Vivenzio, A.; Labbadia, Giancarlo; Mazza, Fabio; D'Alessandri, Giovanna; Russi, G.; Silvestro, Giustina De; Marson, Piero

doi:10.1111/j.1525-1594.2009.00810.x

Cited by 73 publications

(57 citation statements)

References 30 publications

(26 reference statements)

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“…Case studies, 37,38 including a multicenter series, have indicated that TPE is a safe, rapid, and highly effective intervention for emergency management of severe hypertriglyceridemia, effectively preventing related complications. Using TPE in patients with hypertriglycerid emia markedly reduces the serum level of triglycerides, allowing timely measurement of serum levels of electrolytes and reducing the risk for acute pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

Plasmapheresis in the Management of Severe Hypertriglyceridemia

Seda

Meyer

Amundson

et al. 2013

Critical Care Nurse

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P lasmapheresis is an advanced and established extracorporeal therapy in critical care, a process in which plasma, the fluid part of the blood, is separated from blood cells by a device known as a cell separator. In critically ill patients, plasmapheresis is used to remove toxins, medications, destructive antibodies, and clotting factors from the peripheral circulation. During plasmapheresis, a nurse uses a cell separator that either spins the blood to separate the cells from the fluid or filters the blood through a membrane with extremely small pores that allow only the fluid part to pass through. Although in current practice the terms plasmapheresis and therapeutic plasma exchange (TPE) are often used interchangeably, TPE This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Describe use of plasmapheresis for the management of severe hypertriglyceridemia 2. Identify conventional therapeutic modalities used for management of hypertriglyceridemia 3. Discuss effects of hypertriglyceridemia on clinical laboratory tests CNE Continuing Nursing Education CoverPlasmapheresis 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 hypertriglyceridemia in critically ill patients. The impact of the procedure on critical care nursing is growing as nurses become involved in the treatment and follow-up care of patients who have plasmapheresis. (Critical Care Nurse. 2013;33[4]:18-24) 18 CriticalCareNurse Vol 33, No. 4, AUGUST 2013 www.ccnonline.org by AACN on May 9, 2018 http://ccn.aacnjournals.org/ Downloaded from takes the actual plasmapheresis procedure a step further: Plasma is separated from whole blood and discarded, and then a volume of replacement fluid equal to the volume of the discarded plasma is infused. Usually a patient has a needle or a catheter inserted into a vein in each arm, allowing the blood to be taken from one arm and circulated through the cell separator to remove the plasma. The aspiration device on the machine is adjusted to remove the undesirable blood components and then return the rest...

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Section: Discussionmentioning

confidence: 99%

Plasmapheresis in the Management of Severe Hypertriglyceridemia

Seda

Meyer

Amundson

et al. 2013

Critical Care Nurse

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“…Reports have shown a 41% (1,406 to 682 mg/dL) decrease in serum triglycerides after 1 session of apheresis alone [43]. Several studies have shown that apheresis can significantly decrease serum triglycerides and cause both clinical and laboratory improvement when conservative treatment with diet and pharmaceutical drugs fail [30,[44][45][46]. All these studies also stress the importance of performing apheresis as soon as possible to maximize therapeutic benefit.…”

Section: Intravenous Insulin ± Heparinmentioning

confidence: 99%

EmTriglyceride-Induced Pancreatitis: Diagnostic and Therapeutic Approach

Lu¹,

Agito²

2016

GHOA

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Hyper triglyceride-induced pancreatitis is rarely associated with triglyceride levels less than 1000 mg/dl. However, triglyceride levels can drop rapidly with fasting that often accompanies acute pancreatitis. In addition, triglyceride levels can be elevated in the setting of acute pancreatitis as injury to the pancreas causes inadequate lipid metabolism leading to triglyceride elevation. Thus, the question arises whether elevated triglycerides induce acute pancreatitis or vice versa in patients presenting with elevated triglyceride levels. Also, the drop in triglyceride levels associated with fasting may result in failure to consider hyper triglyceridemia as the etiology for acute pancreatitis in a patient who presents with triglyceride levels below 1000 mg/dL. In this review, we discuss the relationship between hyper triglyceridemia and pancreatitis as well as causes of elevated triglyceride levels that must be considered in patients who present with both conditions. In addition, we present an evidence based algorithm that summarizes the approach to hyper triglyceridemia and pancreatitis in the setting of complex medical co-morbidities.

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“…Iako se hipertrigliceridemija u dislipidemijskom pankreatitisu povremeno spontano koriguje, i to značajno sporije (neunošenjem hrane oralnim putem), veoma je značajna efikasna akutna i hronična kontrola nivoa Tg (najbolje <5mmol/L), kako zbog umanjenja ozbiljnosti i složenosti aktuelnog ataka pankreatitisa, tako i zbog prevencije kasnijih, rekurentnih ataka 4,6,9 . Iako su tretmani akutnih dislipidemijskih pankreatitisa složeni, oni pored intenzivnog suportivno-simptomatskog tretmana, uključuju heparinizaciju, intravensku primenu insulina, kao i TIP, dok se hronični tretman nastavlja trajnim higijensko-dijetetskim režimom i primenom fibrata [5][6][7][8] . TIP je za indikaciju dislipidemijskog pankreatitisa svrstana u treću kategoriju bolesti kada se procedura koristi kao adjuvantna terapija.…”

Section: Diskusijaunclassified

The team management of patient suffered of acute severe dyslipidaemic pancreatitis: The experience of one tertiary health centre

Popin-Taric¹,

Gluvić²,

Mitrović³

et al. 2017

Materia medica

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ApstraktU okviru ovog rada prikazan je slučaj bolesnika sa komplikovanim akutnim dislipidemijskim pankreatitisom u čijem je zbrinjavanju učestvovao tim, koji su činili endokrinolozi, gastroenterolozi i transfuziolozi. Dislipidemija, prevashodno tip IV dislipidemije, predstavlja čest uzrok nastanka akutnog pankreatitisa u populaciji mladih ljudi, posebno u slučajevima nezadovoljavajuće komplijanse (neredovno uzimanje preporučenih fibrata i nepridržavanje higijensko-dijetetskog režima). Tretman akutnog pankreatitisa se nezavisno od etiologije, zbog težine stanja, kompleksnosti lečenja i monitoringa bolesnika, sprovodi u Jedinicama intenzivnog lečenja. U slučajevima kada je dislipidemija uzrok akutnog pankreatitisa, često se u sklopu akutnog zbrinjavanja sprovodi i terapijska izmena plazme, kojom se brzo i značajno koriguju nivoi lipida, prevashodno triglicerida. Terapijska izmena plazme zahteva aktivnost transfuzioloških ekipa, koje su u manjim centrima, često nedostupne. AbstractThis article presents a case of patient with acute and complicated dyslipidaemic pancreatitis, managed by team, consisted of the endocrinologists, gastroenterologists and transfusiologists. Dyslipidaemia, predominantly type IV, is a common cause of acute pancreatitis in young patients, especially in the cases of poor compliance (irregular taking of recommended fibrates and failure to comply with the dietary regime). The treatment of acute pancreatitis, regardless of the aetiology, is due to the severity of the condition, the complexity of the treatment, and the monitoring of patients, in the Intensive Care Units. In cases where dyslipidaemia is the cause of acute pancreatitis, in the context of acute care, a therapeutic plasma exchange is often performed. It rapidly and significantly corrects lipid levels, primarily triglycerides. Therapeutic plasma exchange requires the activity of transfusiology team, which are often unavailable in smaller hospitals.

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Therapeutic Plasma Exchange in Patients With Severe Hypertriglyceridemia: A Multicenter Study

Cited by 73 publications

References 30 publications

Plasmapheresis in the Management of Severe Hypertriglyceridemia

Plasmapheresis in the Management of Severe Hypertriglyceridemia

EmTriglyceride-Induced Pancreatitis: Diagnostic and Therapeutic Approach

The team management of patient suffered of acute severe dyslipidaemic pancreatitis: The experience of one tertiary health centre

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