Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia.
BACKGROUND
Severe hypertriglyceridemia (HTG) leads to major complications such as acute pancreatitis. Lipoprotein apheresis has been proposed as a therapeutic tool for decreasing triglyceride levels, although experience is limited.


OBJECTIVE
To describe our experience with double filtration plasmapheresis (DFPP) in patients with severe HTG and pancreatitis in the plasmapheresis unit of a tertiary hospital in Spain.


METHODS
We recruited 4 patients with severe HTG (triglycerides [TGs] >1000 mg/dL) and acute pancreatitis. All the patients underwent DFPP as part of their treatment. Epidemiologic and laboratory data were collected before and after each plasmapheresis session.


RESULTS
The average TG level before plasmapheresis was 3136 mg/dL (35.44 mmol/L; range, 1306-6693 mg/dL, 14.76-75.63 mmol/L), and the average Acute Physiology And Chronic Health Evaluation (APACHE) II level before the first session was 6 (range, 3-8). All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis. The mean number of sessions was 2.1 (range, 1-3), and mean TG level after plasmapheresis was 428 mg/dL (4.84 mmol/L; range, 169-515 mg/dL; 1.91-5.82 mmol/L). After the first session, the mean decrease in TG levels was 69.16% (2169 mg/dL, range, 945-5925 mg/dL; 24.51 mmol/L, range, 10.78-66.95 mmol/L), and after the last session, TG levels fell by 89.09% (2794 mg/dL, range, 945-6198 mg/dL; 31.57 mmol/L, range, 10.68-70.04 mmol/L). None of the patients developed complications related to plasmapheresis.


CONCLUSIONS
According to available evidence and our own experience, DFPP can be an effective and rapid treatment option in patients with severe HTG and complications. However, further research, including randomized controlled studies, is necessary.
Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: isabelgalancarrillo@gmail.com.
Isabel
I
Galán Carrillo
Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Pablo
P
Demelo-Rodriguez
Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
María Luisa
ML
Rodríguez Ferrero
Nephrology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Fernando
F
Anaya
D000328:Adult; D005260:Female; D005374:Filtration; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D010956:Plasmapheresis / Q000379:methods*; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides
Apheresis; Double filtration; Hypercholesterolemia; Hypertriglyceridemia; Pancreatitis