Apheresis Illustrated. Hyper‐triglyceridemic acute pancreatitis: A milky situation

Kuan, K.; Szymanski, James; Carter, Jamal; Walsh, Ronald; Paroder, Monika

doi:10.1002/jca.22016

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…The speed of lowering the triglycerides was the initial advantage of TPE observed by Betterige in 1978 [ 11 ]. The sight of milky plasma being removed from the patient’s circulation [ 44 ] requires almost no additional convincing of TPE efficacy, but as it has turned out over the last few years, the story is not so simple. Timely reduction of serum triglycerides in the early phase of HTG-AP was associated with decreased development of persistent organ failure [ 23 ], which is the hallmark of severe AP.…”

Section: Potential Beneficial Effects Of Tpementioning

confidence: 99%

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

Gubensek

2023

BMC Gastroenterol

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Severe hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis (AP) and is involved in its pathogenesis. Chylomicrons increase blood viscosity and induce ischemia, while free fatty acids induce inflammation and distant organ damage. Conservative treatment options include fasting and insulin; limited evidence shows their comparable efficacy. Plasma exchange might provide more rapid lowering of triglycerides and amelioration of systemic effects of severe AP. Available data from controlled studies show only moderately faster lowering of triglycerides with apheresis (about 70% vs. 50% with conservative treatment within 24 h) and limited data from non-randomized studies show no improvement in clinical outcomes. New evidence is expected soon from ongoing large randomized trials. Until then, insulin may be used in mild HTG-AP and plasma exchange should be considered only in severe HTG-AP, especially if the decline of triglycerides with conservative treatment is slow, and in HTG-AP during pregnancy.

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Section: Potential Beneficial Effects Of Tpementioning

confidence: 99%

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

Gubensek

2023

BMC Gastroenterol

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Factors affecting clinical outcomes of continuous and intermittent plasmapheresis in patients with severe hypertriglyceridemia

Hussein

2024

Ther Apher Dial

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IntroductionAcute hypertriglyceridemia is considered a category III indication for plasmapheresis. The use of plasma as replacement fluid (RF) has been suggested to replace the consumed lipoprotein lipase. Heparin when used as an anticoagulant could possibly release lipoprotein lipase, thereby increasing triglyceride clearance.MethodsThe impact of RF (albumin vs fresh frozen plasma (FFP) and anticoagulant (ACD‐A vs. heparin) on triglycerides following plasmapheresis in 27 patients with severe hypertriglyceridemia (SHTG) was investigated. A paired study of four patients with recurrent SHTG was conducted, evaluating continuous (Optia) versus intermittent flow plasmapheresis (Haemonetics).ResultsShorter procedures positively impacted triglycerides (TG) drop post‐sessions p < 0.05. In albumin sessions, patients who used heparin demonstrated significantly greater drop in TG and required less sessions than did those with citrate p < 0.05. In heparin sessions, patients who used albumin demonstrated significantly greater drop in triglycerides and required less sessions than did those with FFP p < 0.05. Three of six patients who used FFP and heparin showed a triglyceride drop of 11.7% following three sessions and a 50% drop with one albumin session. Compared with Haemonetics, Optia removed comparable volumes of plasma in less time, processing smaller blood volumes and using less citrate p < 0.05. Patients demonstrated significantly lower drop in TG and required more sessions with Haemonetics than they did with Optia p < 0.05.ConclusionShorter procedure was the main predictor for effective TG clearance. This can be achieved by continuous apheresis technology, particularly when using albumin as RF. TG removal via Optia seems to be optimized by using heparin.

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Apheresis Illustrated. Hyper‐triglyceridemic acute pancreatitis: A milky situation

Cited by 2 publications

References 7 publications

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis—a concise review

Factors affecting clinical outcomes of continuous and intermittent plasmapheresis in patients with severe hypertriglyceridemia

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