Hypertriglyceridemia: Is there a role for prophylactic apheresis? A case report

Abstract

A hipertrigliceridemia grave tem sido associada de forma consistente ao aumento do risco cardiovascular e a outras complicações, nomeadamente, pancreatite aguda. Descrevemos um caso de uma mulher de 64 anos, com miocardiopatia hipertrófica e síndrome metabólica com valor sérico de triglicerídeos de 3260 mg/ dL. Foi efectuada plasmaferese e optimizado o tratamento médico para alcançar uma redução rápida e efectiva dos níveis dos triglicerídeos, prevenindo complicações clínicas. Após três sessões de plasmaferese, verificou-se uma redução marcada dos triglicerídeos e do colesterol total. Existem alguns casos descritos na literatura demonstrado a importância da plasmaferese no tratamento da pancreatite aguda em contexto de hipertrigliceridemia grave. Os autores pretendem com este caso demonstrar a aplicabilidade desta técnica em contexto de prevenção primária em doentes com níveis de triglicerídeos extremamente aumentados. ResumoPalavras-chave: doenças cardiovasculares; hipertrigliceridemia; plasmaferese; prevenção primária.Severe hypertriglyceridemia has been consistently associated with an increased risk of cardiovascular disease and other complications, namely acute pancreatitis. We report a case of a 64 year-old woman with hypertrophic cardiomyopathy and metabolic syndrome with triglyceride level of 3260 mg/dL. Plasma exchange was performed with simultaneous medical treatment to achieve a rapid and effective lowering of triglycerides in order to prevent clinical complications. After three plasmapheresis sessions a marked reduction in triglyceride and total cholesterol levels was observed. Several cases have shown the importance of plasmapheresis in the treatment of acute pancreatitis. We intend to demonstrate the applicability of this technique as primary prophylaxis in the presence of extremely high serum triglyceridemia levels. AbstRAct

Role of therapeutic plasma exchange in the treatment of severe hypertriglyceridemia: an experience

“…We intend to demonstrate the applicability of this technique, similar to Francisco and colleagues, as primary prophylaxis in the presence of extremely high serum TG levels. 8 Although TPE is limited due to its high cost and requirement for a specialized center, it is still advisable as prophylaxis for SHTG. This is due to the advantage of preventing serious complications associated with SHTG and safety experience claimed and published by different authors.…”

“…This is due to the advantage of preventing serious complications associated with SHTG and safety experience claimed and published by different authors. 4,[6][7][8] Further, the use of TPE as prophylaxis is beneficial as the time of intervention using TPE might be at critical point. Better results in terms of mortality and morbidity have been achieved in patients as soon as they receive TPE.…”

“…9,10 Patients undergoing repetitive TPE to prevent recurring pancreatitis have a lower risk of pancreatitis, resulting in fewer hospitalizations and reduced health costs. 8,11 Therefore, it is necessary to maintain regular, long-term TPE sessions (e.g. one session every 4 weeks).…”

Uso de isotretinoína por mulheres em idade reprodutiva

“…O aumento do colesterol e LDL e a diminuição de HDL foram constatados, e estes podem contribuir para o acúmulo de colesterol nos vasos, aumento do risco de problemas cardiovasculares e aterosclerose 25 . Além disso, o aumento de triglicerídeos pode ser preocupante em pacientes que já sofrem com essa alteração bioquímica, já que o acúmulo de triglicerídeos pode ocasionar em graves problemas cardiovasculares, pancreatite aguda, xantoma eruptivo, lipemia retinalis e hepatoesplenomegalia 25,26 .…”

Efficacy of Insulin, Heparin and Fenofibrate Combination Treatment in Severe Hypertriglyceridemia: Double Center Experience

“…Some cases are characterized by over-high chylomicrons, presenting with recurrent abdominal pain, nausea, vomiting, and pancreatitis. There is a high likelihood of acute pancreatitis in patients with TG concentrations >500-1000 mg/dL and in chylomicronemia syndrome which appears with TG levels reaching above 2000 mg/dL (7).…”