medigraphic.com
ISSN 2448-8909 (Print)

2015, Number 3

<< Back Next >>

Med Crit 2015; 29 (3)

Aferesis for hipertrigliceridémica acute pancreatitis. A case report and review

Zaragoza JJ, Villa G, Borbolla-Arizti JP, Salgado-Hernández T, Cerón-Díaz U

Language: Spanish
References: 93
Page: 179-188
PDF size: 257.87 Kb.


ABSTRACT

Severe hypertriglyceridemia is associated with various pathologies including acute pancreatitis. The treatment options for hypertriglyceridemic acute pancreatitis include insulin, glucose and heparin infusions and many types of apheresis. Patients may benefit from the prompt use of plasma exchange to reduce lipid levels. The timing of initiation and the type of therapy play a role to achieve the full benefits of the procedure. Blood purification and cytokine removal could be factors for the good outcomes reported in most of the patients. It seems even safe and efficient during pregnancy, a state with high prevalence of hypertriglyceridemia opposed to general population. We present a case report of a 40 year old woman with acute pancreatitis due to hypertriglyceridemia who was treated with a single session of plasma exchange with significant improvement of clinical and hemodynamic parameters and resolution of the acute event. Furthermore, we prepared a literature review in this topic.


REFERENCES

  1. Ewald N, Kloer HU. Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis. Clin Res Cardiol Suppl. 2012;7(Suppl. 1):31-35. doi: 10.1007/ s11789-012-0042-x.

  2. Tsuang W, Navaneethan U, Ruiz L, Palascak JB, Gelrud A. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol. 2009;104(4):984-991. doi: 10.1038/ajg.2009.27.

  3. Sandhu S, Al-Sarraf A, Taraboanta C, Frohlich J, Francis GA. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011;10:157. doi: 10.1186/1476-511X-10-157.

  4. Chang CC, Hsieh YY, Tsai HD, Yang TC, Yeh LS, Hsu TY. Acute pancreatitis in pregnancy. Zhonghua Yi Xue Za Zhi (Taipei). 1998;61(2):85-92.

  5. Yuan G, Al-Shali K, Hegele R. Hypertriglyceridemia: its etiology, effects and treatment. Can Med Assoc J. 2007;176(8):1113-1120.

  6. Ahmed SM, Clasen ME, Donnelly JF. Management of dyslipidemia in adults. Am Fam Physician. 1998;57:2192-2204. doi: 10.1186/1758-5996-1-26.

  7. Sleth JC, Lafforgue E, Servais R, et al. A case of hypertriglycideremia- induced pancreatitis in pregnancy: value of heparin. Ann Fr Anesth Reanim. 2004;23(8):835-837. doi: 10.1016/j.annfar.2004.06.006.

  8. Barbagallo CM, Averna MR, DiMarco T, et al. Effectiveness of cascade fi ltration plasmapheresis in two patients affected by familial hypercholesterolemia. J Clin Apher. 1995;10:96- 100. doi: 10.1002/jca.2920100209.

  9. Barr SI, Kottke BA, Pineda AA, Mao SJ. Plasma lipid and apoprotein levels following plasmapheresis in a subject homozygous for familial hypercholesterolemia. Experientia. 1981;37(2):114-115.

  10. Berger Z, Quera R, Poniachik J, Oksenberg D, Guerrero J. Heparin and insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Experience of 5 cases. Revista Médica de Chile. 2001;129:1373-1378.

  11. Böhler J, Donauer K, Köster W, Schollmeyer PJ, Wieland H, Hörl WH. Biocompatibility of four plasmapheresis membranes in patients treated for hypercholesterolemia. Am J Nephrol. 1991;11(6):479-485.

  12. Franceschini G, Calabresi L, Vaccarino V, Busnach G, Cappelleri A, Sirtori CR. Comparison of dextran sulphate cellulose and double fi ltration plasmaphereses for the treatment of severe hypercholesterolemia. Beitr Infusionsther. 1988;23:112-117.

  13. Busnach G. Lipoprotein plasmapheresis. Cardiologia. 1998;43(9):971-974.

  14. Eisenhauer T, Armstrong VW, Wieland H, Fuchs C, Scheler F, Seidel D. Selective removal of low density lipoproteins (LDL) by precipitation at low pH: fi rst clinical application of the HELP system. Klin Wochenschr. 1987;65(4):161-168.

  15. Frey BM, Fopp M. Therapeutic plasmapheresis-a critical review in the light of the current literature. Schweiz Med Wochenschr. 1993;123(37):1725-1735.

  16. Torres-Colores J, Vadillo-Buenfi l M, González-Bárcena D. Hypertriglyceridemic pancreatitis during pregnancy. A report of a case. Ginecol Obstet Mex. 2006;74(3):170-176.

  17. Apstein CS, Zilversmit DB, Lees RS, George PK. Effect of intessive plasmapheresis on the plasma cholesterol concentration with familial hypercholesterolemia. Atherosclerosis. 1978;31:105-115.

  18. Betteridge DJ, Bakowski M, Taylor KG, Reckless JP, de Silva SR, Galton DJ. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange. Lancet. 1978;1(8078):1368.

  19. Simons LA, Gibson JC, Isbister JP, Biggs JC. The effects of plasma exchange on cholesterol metabolism. Atherosclerosis. 1978;31(2):195-204.

  20. Dairou F, Rottembourg J, Truffert J, et al. Plasma exchange treatment for severe familial hypercholesterolemia: a comparison of two different techniques. Beitr Infusionsther. 1988;23:152-159.

  21. Aubert I, Bombail D, Erlich D, et al. Removal of low density lipoproteins on dextrans sulfate in 2 patients with familial monogenic hypercholesterolemia. Annales de Medecine Interne. 1988;139 Suppl.:72-76.

  22. Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence- based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher. 2013;28:145-284. doi: 10.1002/jca.21276.

  23. Ranson JH. Acute pancreatitis: pathogenesis, outcome and treatment. Clin Gastroenterol. 1984;13(3):843-863.

  24. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223(3):603- 613. doi: 10.1148/radiol.2233010680.

  25. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;2(1):c179-184.

  26. Deleplanque P, Alcalay D, Rouffi neau J, et al. Major hypertriglyceridemia, associated with severe acute pancreatitis, successfully treated with plasma exchange. Ann Med Interne (Paris). 1988;139 Suppl.:86-87.

  27. Durval A, Zamidei L, Bettocchi D, Luzzio M, Consales G. Hyperlipidemic acute pancreatitis: a possible role of antiretroviral therapy with entecavir. Minerva Anestesiol. 2011;77(10):1018-1021.

  28. Flynn WJ, Freeman PG, Wickboldt LG. Pancreatitis associated with isotretinoin-induced hypertriglyceridemia. Ann Intern Med. 1987;107(1):63.

  29. Sevastru S, Wakatsuki M, Fennell J, Grocott MPW. Plasma exchange in the management of a case of hypertriglyceridaemic pancreatitis triggered by venlafaxine. BMJ Case Rep. 2012;2012. doi: 10.1136/bcr.11.2011.5208.

  30. Kfoury-Baz EM, Nassar RA, Tanios RF, et al. Plasmapheresis in asparaginase-induced hypertriglyceridemia. Transfusion. 2008;48(6):1227-1230. doi: 10.1111/j.1537- 2995.2008.01663.x.

  31. Nakagawa M, Kimura S, Fujimoto K, et al. A case report of an adult with severe hyperlipidemia during acute lymphocytic leukemia induction therapy successfully treated with plasmapheresis. Ther Apher Dial. 2008;12(6):509-513. doi: 10.1111/j.1744-9987.2008.00647.x.

  32. Routy JP, Smith GH, Blank DW, Gilfi x BM. Plasmapheresis in the treatment of an acute pancreatitis due to protease inhibitor-induced hypertriglyceridemia. J Clin Apher. 2001;16(3):157-159.

  33. Schaefer JR, Steinmetz A, Dugi K, Ehlenz K, von Wichert P, Kaffarnik H. Oral contraceptive-induced pancreatitis in the hyperchylomicronemia syndrome. Dtsch Med Wochenschr. 1995;120(10):325-328. doi: 10.1055/s-2008-1055349.

  34. Abraham M, Mitchell J, Simsovits D, Gasperino J. Hypertriglyceridemic pancreatitis caused by the oral contraceptive agent estrostep. J Intensive Care Med. 2014. doi: 10.1177/0885066614528083.

  35. Homma Y, Mikami Y, Tamachi H, et al. Comparison of selectivity of LDL removal by double fi ltration and dextransulfate cellulose column plasmapheresis. Atherosclerosis. 1986;60(1):23-27.

  36. Borberg H. Quo vadis haemapheresis. Current developments in haemapheresis. Transfus Apher Sci. 2006;34(1):51-73. doi: 10.1016/j.transci.2005.11.001.

  37. Candrina R, Spandrio S, Cotelli MC, Rossi M, Di Stefano O. Double fi ltration plasmapheresis in the treatment of vascular complications of hyperlipidemia. Recenti Prog Med. 1990;81(4):282-286.

  38. Dominguez-Muñoz JE, Malfertheiner P, Ditschuneit HH, et al. Hyperlipidemia in acute pancreatitis. Relationship with etiology, onset, and severity of the disease. Int J Pancreatol. 10(3-4):261-267.

  39. Gan SI, Edwards AL, Symonds CJ, Beck PL. Hypertriglyceridemia- induced pancreatitis: a case-based review. World J Gastroenterol. 2006;12(44):7197-7202.

  40. Fortson MR, Freedman SN, Webster PD. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol. 1995;90(12):2134-2139.

  41. Hofbauer B, Friess H, Weber A, et al. Hyperlipaemia intensifi es the course of acute oedematous and acute necrotising pancreatitis in the rat. Gut. 1996;38(5):753-758.

  42. Saharia P, Margolis S, Zuidema GD, Cameron JL. Acute pancreatitis with hyperlipemia: studies with an isolated perfused canine pancreas. Surgery. 1977;82(1):60-67.

  43. Jap TS, Jenq SF, Wu YC, Chiu CY, Cheng HM. Mutations in the lipoprotein lipase gene as a cause of hypertriglyceridemia and pancreatitis in Taiwan. Pancreas. 2003;27(2):122-126.

  44. Ma Y, Ooi TC, Liu MS, et al. High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: possible association with apolipoprotein E2 isoform. J Lipid Res. 1994;35(6):1066-1075.

  45. Watts GF, Mitropoulos KA, al-Bahrani A, Reeves BE, Owen JS. Lecithin-cholesterol acyltransferase defi ciency presenting with acute pancreatitis: effect of infusion of normal plasma on triglyceride-rich lipoproteins. J Intern Med. 1995;238(2):137-141.

  46. Bramlage CP, Schröder K, Bramlage P, et al. Predictors of complications in therapeutic plasma exchange. J Clin Apher. 2009;24(6):225-231. doi: 10.1002/jca.20217.

  47. Bose N, Kanzariya H. Role of therapeutic apheresis and phlebotomy techniques in anaesthesia and critical care. Indian J Anaesth. 2014;58(5):672-678. doi: 10.4103/0019-5049.144685.

  48. Chirnside A, Urbaniak SJ, Prowse CV, Keller AJ. Coagulation abnormalities following intensive plasma exchange on the cell separator. II. Effects on factors I, II, V, VII, VIII, IX, X and antithrombin III. Br J Haematol. 1981;48(4):627-634.

  49. Kalinin NN, Petrov MM, Petrova VJ. Therapeutic plasmapheresis using a cell separator. Folia Haematol Int Mag Klin Morphol Blutforsch. 1989;116(2):177-182.

  50. Chen JH, Yeh JH, Lai HW, Liao CS. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol. 2004;10(15):2272-2274.

  51. Furuya T, Komatsu M, Takahashi K, et al. Plasma exchange for hypertriglyceridemic acute necrotizing pancreatitis: report of two cases. Ther Apher. 2002;6(6):454-458.

  52. Iskandar SB, Olive KE. Plasmapheresis as an adjuvant therapy for hypertriglyceridemia-induced pancreatitis. Am J Med Sci. 2004;328(5):290-294.

  53. Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis. World J Gastroenterol. 2003;9(11):2622-2626.

  54. Franceschini G, Busnach G, Vaccarino V, Calabresi L, Gianfranceschi G, Sirtori CR. Apheretic treatment of severe familial hypercholesterolemia: comparison of dextran sulfate cellulose and double membrane fi ltration methods for low density lipoprotein removal. Atherosclerosis. 1988;73(2-3):197-202.

  55. Kadikoylu G, Yukselen V, Yavasoglu I, Coşkun A, Karaoglu AO, Bolaman Z. Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia. Transfus Apher Sci. 2010;43(3):285- 289. doi: 10.1016/j.transci.2010.09.009.

  56. Bae JH, Baek SH, Choi HS, et al. Acute pancreatitis due to hypertriglyceridemia: report of 2 cases. Korean J Gastroenterol. 2005;46(6):475-480.

  57. Rajendran R, Abu E, Fadl A, Byrne CD. Late effects of childhood cancer treatment: severe hypertriglyceridaemia, central obesity, non alcoholic fatty liver disease and diabetes as complications of childhood total body irradiation. Diabet Med. 2013;30(8):e239-242. doi: 10.1111/dme.12234.

  58. Coman T, Dalloz MA, Coolen N, et al. Plasmapheresis for the treatment of acute pancreatitis induced by hemophagocytic syndrome related to hypertriglyceridemia. J Clin Apher. 2003;18(3):129-131. doi: 10.1002/jca.10056.

  59. Giannini G, Valbonesi M, Morelli F, et al. Hypertriglyceridemia: apheretic treatment. Int J Artif Organs. 2005;28(10):1018-1024.

  60. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apher. 2003;18(4):181-185. doi: 10.1002/jca.10063.

  61. Al-Humoud H, Alhumoud E, Al-Hilali N. Therapeutic plasma exchange for acute hyperlipidemic pancreatitis: a case series. Ther Apher Dial. 2008;12(3):202-204. doi: 10.1111/j.1744-9987.2008.00572.x.

  62. Syed H, Bilusic M, Rhondla C, Tavaria A. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: a community hospital’s experience. J Clin Apher. 2010;25(4):229-234. doi: 10.1002/jca.20232.

  63. Jerkovich F, Remón JA, Barretto M, Ciocchini C, Speroni G. Use of plasmapheresis in hypertriglyceridemic pancreatitis. Medicina (B Aires). 2014;74(1):55-56.

  64. Stefanutti C, Di Giacomo S, Labbadia G. Timing clinical events in the treatment of pancreatitis and hypertriglyceridemia with therapeutic plasmapheresis. Transfus Apher Sci. 2011;45(1):3-7. doi: 10.1016/j.transci.2011.06.013.

  65. Mayan H, Gurevitz O, Mouallem M, Farfel Z. Multiple spurious laboratory results in a patient with hyperlipemic pancreatitis treated by plasmapheresis. Isr J Med Sci. 1996;32(9):762-766.

  66. Bhavsar B, Bhatt A. Steroid induced hyperlipidemic pancreatitis and new onset diabetes mellitus. Treatment with plasmapheresis. JOP. 2008;9(5):664-665.

  67. Bota VM. Urgent apheresis combined with insulin infusion in hypertriglyceridemia-induced acute pancreatitis. Am J Emerg Med. 2013;31(2):452.e1-2. doi: 10.1016/j. ajem.2012.06.027.

  68. Kyriakidis AV, Karydakis P, Neofytou N, et al. Plasmapheresis in the management of acute severe hyperlipidemic pancreatitis: report of 5 cases. Pancreatology. 2005;5(2- 3):201-204. doi: 10.1159/000085272.

  69. Stefanutti C, Morozzi C, Petta A. Lipid and low-densitylipoprotein apheresis. Effects on plasma inflammatory profi le and on cytokine pattern in patients with severe dyslipidemia. Cytokine. 2011;56(3):842-849. doi: 10.1016/j. cyto.2011.08.027.

  70. Surbatovic M, Veljovic M, Jevdjic J, Popovic N, Djordjevic D, Radakovic S. Immunoinfl ammatory response in critically ill patients: severe sepsis and/or trauma. Mediators Infl amm. 2013;2013:362793. doi: 10.1155/2013/362793.

  71. Chelazzi C. Use of continuous venovenous hemodiafi ltration with a high cutoff membrane in a patient with severe acute pancreatitis. Open J Nephrol. 2012;02(04):78-81. doi: 10.4236/ojneph.2012.24013.

  72. Stegmayr BG, Banga R, Berggren L, Norda R, Rydvall A, Vikerfors T. Plasma exchange as rescue therapy in multiple organ failure including acute renal failure. Crit Care Med. 2003;31(6):1730-1736. doi: 10.1097/01. CCM.0000064742.00981.14.

  73. Stegmayr BG. Plasma exchange in patients with septic shock including acute renal failure. Blood Purif. 1996;14(1):102-108.

  74. Sadeghi M, Daniel V, Wang H, et al. Plasmapheresis adjusts infl ammatory responses in potential kidney transplant recipients. Transplantation. 2013;95(8):1021-1029. doi: 10.1097/TP.0b013e318286191b.

  75. Kohli RS, Bleibel W, Shetty A, Dhanjal U. Plasmapheresis in the treatment of hypertriglyceridemic pancreatitis with ARDS. Dig Dis Sci. 2006;51(12):2287-2291. doi: 10.1007/ s10620-006-9315-x.

  76. Piolot A, Nadler F, Cavallero E, Coquard JL, Jacotot B. Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas. 1996;13(1):96-99.

  77. Beyrouti MI, Beyrouti R, Ben Amar M, et al. Acute hyperlipemic pancreatitis (2 cases). Tunis Med. 2007;85(7):610-613.

  78. Hen K, Bogdański P, Pupek-Musialik D. Successful treatment of severe hypertriglyceridemia with plasmapheresiscase report. Pol Merkur Lekarski. 2009;26(151):62-64.

  79. Hovland A, Hardersen R, Mollnes TE, Lappegård KT. Selective whole blood lipoprotein apheresis to prevent pancreatitis in drug refractory hypertriglyceridemia. JOP. 2010;11(5):467-469.

  80. Izquierdo-Ortiz MJ, Abaigar-Luquin P. Severe hypertriglyceridaemia. Treatment with plasmapheresis. Nefrologia. 2012;32(3):417-418. doi: 10.3265/Nefrologia.pre2012. Feb.11394.

  81. Manrique-Franco K, Sánchez-Vilar Burdiel O, Aragón- Valera C, Sánchez-Fernández MS, Rovira-Loscos A. Plasmapheresis as treatment for severe hypertriglyceridemia. Endocrinol Nutr. 2011;58(6):319-320. doi: 10.1016/j.endonu. 2010.12.007.

  82. Yeh JH, Lee MF, Chiu HC. Plasmapheresis for severe lipemia: comparison of serum-lipid clearance rates for the plasma- exchange and double-fi ltration variants. J Clin Apher. 2003;18(1):32-36. doi: 10.1002/jca.10047.

  83. Basar R, Uzum AK, Canbaz B, et al. Therapeutic apheresis for severe hypertriglyceridemia in pregnancy. Arch Gynecol Obstet. 2013;287(5):839-8343. doi: 10.1007/s00404-013- 2786-z.

  84. Warth MR, Arky RA, Knopp RH. Lipid metabolism in pregnancy. II. Altered lipid composition in intermediate, very low, low and high-density lipoprotein fractions. J Clin Endocrinol Metab. 1975;41(4):649-655. doi: 10.1210/jcem-41-4-649.

  85. Khan AS, Latif SU, Eloubeidi MA. Controversies in the etiologies of acute pancreatitis. JOP. 2010;11(6):545-552.

  86. Gürsoy A, Kulaksizoglu M, Sahin M, et al. Severe hypertriglyceridemia- induced pancreatitis during pregnancy. J Natl Med Assoc. 2006;98(4):655-657.

  87. Eddy JJ, Gideonsen MD, Song JY, Grobman WA, O’Halloran P. Pancreatitis in pregnancy. Obstet Gynecol. 2008;112(5):1075-1081. doi: 10.1097/ AOG.0b013e318185a032.

  88. Parulekar PS, Gidden F, Yavari A. A sticky situation. QJM. 2012;105(9):887-889. doi: 10.1093/qjmed/hcr110.

  89. Majlis S, Anguita T, Weishaupt R, Socias M. Plasmapheresis in acute pancreatitis secondary to familial hyperlipidemia in a pregnant woman. Rev Med Chil. 1989;117(11):1275- 1278.

  90. Exbrayat V, Morel J, De Filippis JP, Tourne G, Jospe R, Auboyer C. Hypertriglyceridemia-induced pancreatitis in pregnancy. A case report. Ann Fr Anesth Reanim. 2007;26(7-8):677-679. doi: 10.1016/j.annfar.2007.04.003.

  91. Lennertz A, Parhofer KG, Samtleben W, Bosch T. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Ther Apher. 1999;3(3):227-233.

  92. Madhra M, Noh RM, Zammitt NN, Patrick AW, Love CDB. A complicated pregnancy in a patient with lipodystrophic diabetes attributable to a peroxisome proliferator- activated receptor gamma (PPARG) mutation. Diabet Med. 2012;29(10):e398-401. doi: 10.1111/j.1464- 5491.2012.03742.x.

  93. Sivakumaran P, Tabak SW, Gregory K, Pepkowitz SH, Klapper EB. Management of familial hypertriglyceridemia during pregnancy with plasma exchange. J Clin Apher. 2009;24(1):42-46. doi: 10.1002/jca.20192.




2020     |     www.medigraphic.com