H Syed1, M Bilusic, C Rhondla, A Tavaria. 1. Department of Internal Medicine, Trinitas Regional Medical Center, Seton Hall University School of Health and Medical Sciences, Elizabeth, New Jersey, USA. husnainsyed@hotmail.com
Abstract
BACKGROUND: Hyperlipidemic pancreatitis is a potentially fatal complication of hypertriglyceridemia (HTG). The current mainstay of treatment for the hypertriglyceridemia associated with pancreatitis includes heparin, insulin and lipid lowering agents. Experiences with plasmapheresis are limited. Here, we report our experience using plasmapheresis in the treatment of four patients with acute severe HTG-induced pancreatitis. METHODS: Four patients with acute severe HTG-induced pancreatitis due to severe primary hyperlipidemia exacerbated by secondary factors were studied. In addition to the standard treatment (insulin or heparin infusion), antibiotics and lipid lowering agents, two were treated within the first 48 hours, and two with early (<24 hours) plasmapheresis with 5% albumin. RESULTS: All four patients had a significant improvement in their triglyceride levels using plasmapheresis with an average reduction in TG levels of 70.4% per treatment and 89.3% with the first treatment. However, there was no clear relation between the use of plasmapheresis and either improvement in APACHE II scores, length of stay in either the ICU or overall hospital length of stay or in the prevention of complications secondary to severe pancreatitis, including in the two patients who received plasmapheresis in the first 24 hours. CONCLUSION: Our report showed that plasmapheresis was successful in lowering TG levels. However, in the absence of a comparison with standard treatment (heparin or insulin infusion and lipid lowering agents) the effect of plasmapheresis on lowering the morbidity and length of stay of patients with HTG-induced acute severe pancreatitis is uncertain and warrants further investigation into its efficacy.
BACKGROUND:Hyperlipidemic pancreatitis is a potentially fatal complication of hypertriglyceridemia (HTG). The current mainstay of treatment for the hypertriglyceridemia associated with pancreatitis includes heparin, insulin and lipid lowering agents. Experiences with plasmapheresis are limited. Here, we report our experience using plasmapheresis in the treatment of four patients with acute severe HTG-induced pancreatitis. METHODS: Four patients with acute severe HTG-induced pancreatitis due to severe primary hyperlipidemia exacerbated by secondary factors were studied. In addition to the standard treatment (insulin or heparin infusion), antibiotics and lipid lowering agents, two were treated within the first 48 hours, and two with early (<24 hours) plasmapheresis with 5% albumin. RESULTS: All four patients had a significant improvement in their triglyceride levels using plasmapheresis with an average reduction in TG levels of 70.4% per treatment and 89.3% with the first treatment. However, there was no clear relation between the use of plasmapheresis and either improvement in APACHE II scores, length of stay in either the ICU or overall hospital length of stay or in the prevention of complications secondary to severe pancreatitis, including in the two patients who received plasmapheresis in the first 24 hours. CONCLUSION: Our report showed that plasmapheresis was successful in lowering TG levels. However, in the absence of a comparison with standard treatment (heparin or insulin infusion and lipid lowering agents) the effect of plasmapheresis on lowering the morbidity and length of stay of patients with HTG-induced acute severe pancreatitis is uncertain and warrants further investigation into its efficacy.