title: Therapeutic apheresis for severe hypertriglyceridemia in pregnancy.
abstract: BACKGROUND
  During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain <300 mg/dl. In women with genetic forms of hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy.
  
  
  METHODS
  We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used.
  
  
  CONCLUSIONS
  When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.
authors.affiliation: Department of Internal Medicine, Istanbul University, Istanbul Medical Faculty, Capa, Istanbul, 34390, Turkey.
authors.forename: Rafet
authors.initials: R
authors.lastname: Basar
authors.forename: Ayse Kubat
authors.initials: AK
authors.lastname: Uzum
authors.forename: Bulent
authors.initials: B
authors.lastname: Canbaz
authors.forename: Sema Ciftci
authors.initials: SC
authors.lastname: Dogansen
authors.forename: Sevgi
authors.initials: S
authors.lastname: Kalayoglu-Besisik
authors.forename: Senem
authors.initials: S
authors.lastname: Altay-Dadin
authors.forename: Ferihan
authors.initials: F
authors.lastname: Aral
authors.forename: Nese Colak
authors.initials: NC
authors.lastname: Ozbey
mesh_terms: D000208:Acute Disease; D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D002585:Cesarean Section; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D005374:Filtration / Q000379:methods; D005865:Gestational Age; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications* / Q000628:therapy*; D008297:Male; D010195:Pancreatitis / Q000209:etiology; D010956:Plasmapheresis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome
chemical_list: D015525:Fatty Acids, Omega-3