Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases
Abstract
Acute pancreatitis is a potentially life-threatening disease. If the diagnosis and the treatment are not prompt, it can rapidly evolve to a medical emergency. Severe hypertriglyceridemia, defined as above 1000 mg/dl, is the third most common cause of acute pancreatitis. Conventional management includes fat dietary restriction and pharmacological treatment; however, these measures take time to be effective. Plasmapheresis seems to be an alternative and safe adjunctive therapy because it allows the rapid reduction of the trigger agent in circulation. Its use, especially in severe cases, has been increasingly reported. The authors report three cases of severe hypertriglyceridemia-induced pancreatitis in which early plasmapheresis was successfully used with other supportive clinical management.
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Cappell M. Acute pancreatitis: Etiology, clinical presentation, diagnosis, and therapy. Med Clin North Am. 2008;92(4):889–923. http://dx.doi.org/10.1016/j.mcna.2008.04.013
Nasa P, Alexander G, Kulkarni A, Juneja D, Sehra S, Agarwal R, et al. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis. Indian J Crit Care Med. 2015;19(8):487. http://dx.doi.org/10.4103/0972-5229.162472
Anderson F, Thomson S, Clarke D, Buccimazza I. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes. Pancreatology. 2009;9(3):252–7. http://dx.doi.org/10.1159/000212091
Ewald N, Kloer H. Treatment options for severe hypertriglyceridemia (SHTG): The role of apheresis. Clin Res Cardiol Suppl. 2012;7(Suppl 1):31–5. http://dx.doi.org/10.1007/s11789-012-0042-x
Eren G, Hergünsel O, Altun D, Cukurova Z, Yasar L. An alternative treatment in hypertriglyceridemia-induced acute pancreatitis in pregnancy: Plasmapheresis. J Anaesthesiol Clin Pharmacol. 2012;28(2):252. http://dx.doi.org/10.4103/0970-9185.94913
Winters J. 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(4):191–3. http://dx.doi.org/10.1002/jca.21334
Faydhi A, Mohidin S, Al Eidarous S. Use of plasmapheresis in acute pancreatitis secondary to hypertriglyceridemia. Univers J Med Sci. 2015;3(1):28–32. http://doi.org/10.13189/ujmsj.2015.030104
Banks P, Freeman M. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400. http://dx.doi.org/10.1111/j.1572-0241.2006.00856.x
Tampieri A, Cenni P, Morselli C, Lenzi T. Plasmapheresis in hypertriglyceridemia-related pancreatitis: A case report. Emerg Care J. 2012;8(2):9. http://dx.doi.org/10.4081/ecj.2012.2.9
AbouRjaili G, Shtaynberg N, Wetz R, Costantino T, Abela G. Current concepts in triglyceride metabolism, pathophysiology, and treatment. Metabolism. 2010;59(8):1210–20. http://dx.doi.org/10.1016/j.metabol.2009.11.014
Collis L, Chambers D, Carr B. Hypertriglyceridaemia-induced acute pancreatitis: Is plasmapheresis really indicated? 3C00. J Intensive Care Soc. 2014;15(1):66–9. http://dx.doi.org/10.1177/175114371401500115
Chang C-C, Hsieh YY, Tsai HD, Yang TC, Yeh LS, Hsu TY. Acute pancreatitis in pregnancy. Chin Med J. 1998;61(2):85–92.
Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham S, 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(4):450–8. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.637793
Betteridge D, Bakowski M, Taylor K, Reckless J, De Silva S, Galton D. Treatment of severe diabetic hypertriglyceridemia by plasma exchange. Lancet. 1978;311(8078):1368. http://dx.doi.org/10.1016/S0140-6736(78)92450-9
Ewald N, Kloer H. Severe hypertriglyceridemia: An indication for apheresis? Atheroscler Suppl. 2009;10(5):49–52. http://dx.doi.org/10.1016/S1567-5688(09)71810-0
Yeh J, Chen J, Chiu H. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher. 2003;18(4):181–5. http://dx.doi.org/10.1002/jca.10063
Ramírez-Bueno A, Salazar-Ramírez C, Cota-Delgado F, de la Torre-Prados M, Valdivielso P. Plasmapheresis as treatment for hyperlipidemic pancreatitis. Eur J Intern Med. 2014;25(2):160–3. http://dx.doi.org/10.1016/j.ejim.2013.08.701
Rehmanjan M. Is plasmapheresis the optimal treatment option for acute pancreatitis secondary to hypertriglyceridemia? A systematic review. Discover Oppor Gen Pract. 2013;19–22.
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(7):e102748. http://dx.doi.org/10.1371/journal.pone.0102748
Syed H, Bilusic M, Rhondla C, Tavaria A. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: A community hospital's experience. J Clin Apher. 2010;25(4):229–34. http://dx.doi.org/10.1002/jca.20232
Yadav D, Pitchumoni C. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36(1):54–62. http://dx.doi.org/10.1097/00004836-200301000-00016
Maher N, Ramaswamykanive H. Use of plasmapheresis in managing the diagnostic dilemma of symptomatic hypertriglyceridemia. Case Rep Gastrointest Med. 2012;2012:1–3. http://dx.doi.org/10.1155/2012/501373
Stefanutti C, Julius U. Treatment of primary hypertriglyceridemia states – General approach and the role of extracorporeal methods. Atheroscler Suppl. 2015;18:85–94. http://dx.doi.org/10.1016/j.atherosclerosissup.2015.02.017
Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial. 2013;17(2):130–7. http://dx.doi.org/10.1111/1744-9987.12008
Zeitler H, Balta Z, Klein B, Strassburg C. Extracorporeal treatment in severe hypertriglyceridemia-induced pancreatitis. Ther Apher Dial. 2015;19(4):405–10. http://dx.doi.org/10.1111/1744-9987.12286
Schwartz J, Padmanabhan A, Aqui N, Balogun R, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: The seventh special issue. J Clin Apher. 2016;31(3):149–338. http://dx.doi.org/10.1002/jca.21470
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Copyright (c) 2017 Andreia Campos, Josefina Santos, Cristina Freitas, Ana Castro, Sofia Santos, JP Pimentel, António Cabrita
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