Plasmapheresis for severe lipemia: comparison of serum-lipid clearance rates for the plasma-exchange and double-filtration variants.

Patients with extremely high triglyceride levels and associated lipemia are at high risk for acute pancreatitis. To evaluate plasmapheresis efficacy for severe hypertriglyceridemia, 18 patients who had not responded to previous therapies were selected for either the plasma-exchange (PE) or double-filtration (DF) treatment variants. After treatment, the mean serum concentrations for triglyceride and cholesterol fell significantly from 1,977.1 and 436.7 mg/dl to 692.6 and 222 mg/dl, respectively. The cholesterol-removal rate was significantly higher for the PE group (P = 0.0082), which also had a lower incidence of hemolysis during the plasmapheresis treatment (P = 0.0430). Improved clearance of serum triglyceride was strongly associated with a lower level of maximal transmembrane pressure (TMP; P = 0.0030), reduced plasmapheresis duration (P = 0.0035), and higher rates of plasma (P = 0.0255) and blood flow (P = 0.0480) during plasmapheresis. In comparison to reports in the literature, the removal rates for serum lipids were lower in our study, possibly as a consequence of early saturation of the plasma separator resulting from blockage caused by the extremely high level of triglyceride-containing lipoproteins. Therefore, PE may be more suitable for the initial treatment of severe hypertriglyceridemia as saturation is prevented. Increasing blood and plasma flow rates, reduction of the TMP level, and reducing effective plasmapheresis duration will improve the clearance of serum lipids during treatment. Copyright 2003 Wiley-Liss, Inc.