Plasma Exchange for Dramatic Gestational Hyperlipidemic Pancreatitis

Saravanan, P.; Blumenthal, Stanley A.; Anderson, C. C.; Stein, Robert B.; Berkelhammer, Charles

doi:10.1097/00004836-199606000-00011

Cited by 27 publications

(18 citation statements)

References 26 publications

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“…Hormonal changes in pregnancy predispose to increased triglyceride levels, but only patients with genetic abnormalities in lipoprotein metabolism are prone to severe gestational hypertiglyceridemia [7]. In most cases of gestational hypertriglyceridemia reported in the literature, TPE was not initiated in the absence of pancreatitis [4][5][6][7][8][9] despite the established association of pancreatitis with life-threatening fetal complications and increased maternal mortality [12].…”

Section: Discussionmentioning

confidence: 99%

“…The combination of these phenomena result in an increase in VLDL production coupled with reduced triglyceride clearance, leading to a net increase in serum triglyceride levels [23]. In normal individuals this increase is modest, but in those who have deficiencies in lipoprotein lipase or apoprotein C-II (i.e., familial hyperlipidemia syndromes I, IV, and V), this increased VLDL synthesis can not be controlled and the result is severe hypertriglyceridemia [7]. TPE results in rapid reductions in triglyceride levels and offers a safe and feasible option for management of hypertriglyceridemia during pregnancy, when avoidance of fibrates is desirable.…”

Section: Discussionmentioning

confidence: 99%

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Management of familial hypertriglyceridemia during pregnancy with plasma exchange

Sivakumaran

Tabak

Gregory

et al. 2009

J of Clinical Apheresis

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Hypertriglyceridemia-induced pancreatitis is a serious complication of familial dyslipidemias. Hormonal influences during pregnancy can compromise otherwise controlled lipid levels in women with familial hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity in both mother and fetus. We report the successful use of therapeutic plasma exchange (TPE) in the management of hypertriglyceridemia during pregnancy resulting in avoidance of pancreatitis and delivery of a healthy term infant. Thirteen TPEs were performed from 19 to 36 weeks gestation to maintain tight control of triglyceride levels.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of familial hypertriglyceridemia during pregnancy with plasma exchange

Sivakumaran

Tabak

Gregory

et al. 2009

J of Clinical Apheresis

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“…Auch hier kann aber Schmerzfreiheit erst nach deutlich mehr als 24 h erwartet werden [3], was im Spezialfall der Schwangeren ein zu langer Zeitraum sein kann. Weitere Autoren beschreiben das Verfahren der Plasmapherese als therapeutische Intervention bei hypertriglyzeridämieinduzierter Pankreatitis [2,6]. Die Plasmapherese eignet sich zur raschen und effektiven Senkung der Triglyzeride, und es wird über Beschwerdefreiheit der behandelten Patienten innerhalb weniger Stunden berichtet [2].…”

Section: Verlaufunclassified

Exzessive Hyperchylomikron�mie - eine seltene Ursache f�r akuten Thorax- und Oberbauchschmerz in der Schwangerschaft

Sattler¹,

Bock²,

Schmidt³

et al. 2003

Herz

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“…In this study, the average level of triglyceride was reduced by one third after the first plasmapheresis. Saravanan et al showed that the level of triglyceride was reduced by 73 and 82 %, respectively, after the second plasmapheresis [2]. As for the timing of plasmapheresis, the results were different in the literatures [3].…”

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confidence: 97%

Plasmapheresis for the treatment of hypertriglyceridemia-induced severe acute pancreatitis in pregnancy: it could be a good choice

Zheng

Wang

et al. 2015

Int J Colorectal Dis

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Dear Editor: Acute pancreatitis (AP) in pregnancy is a rare event with an incidence rate of about three cases per 10,000 pregnancies [1]. The most common cause of AP in pregnancy is gallstones, while the relatively rare cause in pregnancy is hypertriglyceridemia-induced pancreatitis. However, nongallstone pancreatitis is associated with more complications and poorer outcome, for example, hypertriglyceridemiainduced AP. Moreover, pregnancy is a special period as pregnancy-related physiological alterations influence the diagnosis and management for many diseases. Severe acute pancreatitis (SAP) in pregnancy severely affected mother and fetus and developed a serious condition resulting in a higher risk of intrauterine fetal death; therefore, how to manage hypertriglyceridemia-induced SAP in pregnancy remains challenging. In this letter, we reviewed the management of hypertriglyceridemia-induced SAP in pregnancy for a 10-year single-center experience. This is a retrospective study of 10 years conducted at Intensive Care Unit of Hangzhou First People's Hospital in China from June 2004 to June 2014. The study included 39 patients with hypertriglyceridemia-induced SAP in pregnancy, and the diagnosis was based on an elevated serum amylase and/ or a lipase level higher than three times the normal values; all patients' Ranson scores were more than 3. The average age of 39 patients was 27.6±5.0 (21-38)years, the pregnancy weeks of all patients were more than 28 weeks. None was found with gallstones and/or common bile duct stones by ultrasound and/or magnetic resonance cholangiopancreatography. The average value of triglyceride was 24.32±6.59 (9.36-35.68)mmol/L, blood amylase was 737.52±331.42 U/L, urine amylase was 7814.59 ± 2132.25 U/L, and white blood cell count was 20.26±4.38×10 9 /L. Computed tomography showed pancreatic swelling, local necrosis with effusion, fuzzy boundary, and ascites in all of patients. The average value of acute physiology and chronic health evaluation II(APACHE II) was 14.3±3.2 at admission. All patients received ventilator treatment because of systemic instability, 35 cases of acute respiratory failure and 4 cases of ketoacidosis. All patients with intrauterine fetal distress received uterine incision deliveries; then, they were treated mainly by plasmapheresis besides the conventional therapy including inhibition of gastric acid and trypsin secretion, nutritional support, anti-inflammatory therapy, and correction of water-electrolyte imbalance and acid-base disturbance. Plasmapheresis was performed within 24 h of admission for all patients, 1600 to 2400 mL for each time and two to five times for each patient. The average value of triglyceride dropped to 15.28±5.43 mmol/L after the first plasmapheresis. Moreover, the average value of APACHE II was 6.8±2.4 at 72 h after admission. In 39 patients, two cases of pregnant women and one case of fetus died; other patients were cured and discharged, and the rescued success rate was 94.9 %.Lipids level occurring with physiological change in normal pregnan...

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Plasma Exchange for Dramatic Gestational Hyperlipidemic Pancreatitis

Cited by 27 publications

References 26 publications

Management of familial hypertriglyceridemia during pregnancy with plasma exchange

Management of familial hypertriglyceridemia during pregnancy with plasma exchange

Exzessive Hyperchylomikron�mie - eine seltene Ursache f�r akuten Thorax- und Oberbauchschmerz in der Schwangerschaft

Plasmapheresis for the treatment of hypertriglyceridemia-induced severe acute pancreatitis in pregnancy: it could be a good choice

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