Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases
Main Article Content
Keywords
acute pancreatitis, plasmapheresis, severe hypertriglyceridemia
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.
References
1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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.
13. 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
14. 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
15. 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
16. 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
17. 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
18. Rehmanjan M. Is plasmapheresis the optimal treatment option for acute pancreatitis secondary to hypertriglyceridemia? A systematic review. Discover Oppor Gen Pract. 2013;19–22.
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
25. 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
26. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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.
13. 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
14. 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
15. 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
16. 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
17. 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
18. Rehmanjan M. Is plasmapheresis the optimal treatment option for acute pancreatitis secondary to hypertriglyceridemia? A systematic review. Discover Oppor Gen Pract. 2013;19–22.
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
25. 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
26. 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
Article Sidebar
Published
Feb 3, 2017
Article Details
How to Cite
Plasmapheresis in the Management of Acute Pancreatitis due to Severe Hypertriglyceridemia—Reporting New Cases. (2017). Journal of Renal and Hepatic Disorders, 1(1), 29-34. https://doi.org/10.15586/jrenhep.2017.3
Section
Case Reports Hepatology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.