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Long‐term plasma exchange for severe refractory hypertriglyceridemia: A decade of experience demonstrates safety and efficacy
Author(s) -
SchaapFogler Michal,
Schurr Daniel,
Schaap Tova,
Leitersdorf Eran,
Rund Deborah
Publication year - 2009
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.20224
Subject(s) - medicine , hypertriglyceridemia , refractory (planetary science) , pancreatitis , dyslipidemia , apheresis , acute pancreatitis , hyperlipidemia , therapeutic plasma exchange , intensive care medicine , pediatrics , gastroenterology , surgery , disease , diabetes mellitus , triglyceride , cholesterol , endocrinology , platelet , physics , astrobiology
Hypertriglyceridemia (hyperTG) is a common form of dyslipidemia and is frequently associated with premature coronary disease, and when severe, recurrent events of pancreatitis may occur. The management of hyperTG is generally medical (life style modification, medications). Plasma exchange (PE) has been reported to be useful in emergency situations particularly when acute pancreatitis results from extreme hyperTG. To our knowledge, there is only one report on long‐term use of PE for hyperTG. We here report our results of long‐term treatment of hyperTG in 6 patients with Frederickson Type V hyperlipidemia who had recurrent attacks of pancreatitis due to hyperTG refractory to medical therapy. PE was performed from one to eight times a month, mostly using a Cobe Spectra apparatus. In total, our center has performed a total of 1,593 PE sessions for hyperTG. There were no safety issues associated with PE for hyperTG other than occasional access problems (clotted fistula, IV access problems). Determination of plasma TG levels before and after PE demonstrated high efficiency of TG removal (42% to 58% reduction). There was marked clinical improvement in recurrent pancreatitis; patients had a major decrease in episodes (39% to 100%) while on regular PE, as long as they adhered to the treatment schedule. We conclude that long‐term PE for hyperTG, while costly, is feasible and safe and may reduce recurrent attacks of pancreatitis. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.