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Plasmaphoresis — Yes or No?
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It is no secret that I am a “bone head,” literally and figuratively, but from time to time, I encounter uncommon non-skeletal conditions, in this case marked hypertriglyceridemia.
I have previously blogged about a patient with triglyceride levels slightly greater than 5,000. He responded well to plasmaphoresis and has managed to keep his triglyceride levels under control (not bad for a young man previously treated for acute myeloid leukemia). And he has subsequently fathered two wonderful children.
More recently, I was consulted about a patient admitted for acute pancreatitis with an associated triglyceride level in the 1400s. My first thought was that he, too, should be treated with plasmaphoresis and this was confirmed on “UpToDate,” which recommended this treatment for patients with pancreatitis and triglyceride levels >1000.
The following morning I received a call from the primary physician letting me know that while preparing for plasmaphoresis, the patient’s triglyceride level had fallen to ~850 but he was still troubled by acute pancreatitis. Plasmaphoresis is no longer indicated in this patient.
Off to PubMed, where I found 154 citations with abstracts available on the topic “Pancreatitis with Hypertriglyceridemia” over the past 5 years. No, I did not read them all, but I selected the four most recent articles that I think are worthwhile reading; they are listed below.
The options for treating triglyceride induced acute pancreatitis are many but there is some dispute about the use of plasmaphoresis.
As always, your opinions are welcome.
For more information:
Castro FS. Rev Bras Ter Intensiva. 2012 Sep;24(3):302-307.
Twilla JD. Am J Health Syst Pharm. 2012; doi: 10.2146/ajhp110144.
Ramirez-Bueno A. Eur J Intern Med. 2013; doi: 10.1016/j.ejim.2013.08.701. [Epub ahead of print].
Scherer J. J Clin Gastroenterol. 2013; Oct 28. [Epub ahead of print].