From the Guidelines
Plasmapheresis should be considered as a treatment option for acute pancreatitis caused by severe hypertriglyceridemia, as it can rapidly remove triglycerides from circulation and reduce pancreatic inflammation. This is based on the evidence that treatment of hypertriglyceridemia may dramatically improve outcomes and prevent further pancreatic damage 1. The goal of treatment is to maintain triglyceride levels within the normal range, and plasmapheresis has been used to lower lipid and pancreatic enzymes levels, and to improve the signs and symptoms of acute pancreatitis.
Some key points to consider when using plasmapheresis for hypertriglyceridemia-associated pancreatitis include:
- The procedure can rapidly remove triglycerides from circulation, reducing pancreatic inflammation and preventing further damage
- It is particularly beneficial in patients with severe symptoms or complications, or when triglyceride levels exceed 2000 mg/dL
- A typical plasmapheresis regimen involves 1-3 sessions on consecutive days, with each session processing 1-1.5 times the patient's plasma volume
- Patients should receive standard supportive care for pancreatitis, including nothing by mouth, IV fluids, pain management, and monitoring for complications
It is also important to note that lipoprotein apheresis may be even more effective than plasmapheresis, as it removes only large molecular weight complexes from plasma and retains immunoglobulins, albumin, and clotting factors, reducing the possibility of infection and bleeding 1. However, plasmapheresis is still a viable treatment option, especially when lipoprotein apheresis is not available. After the acute episode resolves, patients need long-term management with fibrates, omega-3 fatty acids, and lifestyle modifications to prevent recurrence of hypertriglyceridemia and pancreatitis.
From the Research
Plasmapheresis for Pancreatitis due to Hypertriglyceridemia
- Plasmapheresis has been proposed as a therapeutic tool for decreasing triglyceride levels in patients with severe hypertriglyceridemia-associated acute pancreatitis 2, 3.
- Studies have shown that plasmapheresis can be an effective and rapid treatment option in patients with severe hypertriglyceridemia and complications, with significant improvements in triglyceride levels after treatment 2, 3.
- However, other studies have suggested that conservative management, including fasting, intravenous fluids, and high-dose insulin, may be a successful alternative to plasmapheresis in patients with hypertriglyceridemia-induced acute pancreatitis 4, 5.
Comparison of Plasmapheresis and Conservative Management
- A retrospective study found that there was no significant difference in mortality between patients treated with plasmapheresis and those managed conservatively, but plasmapheresis was associated with greater morbidity 5.
- Another study found that the rate of serum triglyceride decrease was not improved following plasmapheresis compared to conservative management 5.
- However, a more recent study found that plasmapheresis helped to rapidly reduce triglyceride levels in patients with hypertriglyceridemia-associated acute pancreatitis, and that plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis 6.
Efficacy and Safety of Plasmapheresis
- Studies have shown that plasmapheresis can be an effective treatment option for patients with severe hypertriglyceridemia-associated acute pancreatitis, with significant improvements in triglyceride levels after treatment 2, 3, 6.
- However, further research, including randomized controlled studies, is necessary to confirm the efficacy and safety of plasmapheresis in this patient population 2, 3, 5.