A case published in Hawai’i Journal of Medicine & Public Health reports on a young man who was admitted 11 times over 7 years for hypertriglyceridemia-induced pancreatitis (HIP). 

The 25-year-old patient had a history of familial hypertriglyceridemia, hypertension, obstructive sleep apnea, and morbid obesity. At the time of his last admission, he was taking atorvastatin, niacin, fenofibrate, fish oils, aspirin, and losartan. Doctors ruled out common causes of acute pancreatitis as the patient denied alcohol use and multiple imaging studies showed no evidence of cholelithiasis or other biliary disease

The patient’s average serum triglyceride (TG) level per episode was 2,325mg/dL (standard deviation 1,580mg/dL). For his first 10 admissions, he received IV fluids, analgesia, and bowel rest. During his 11th admission, he developed oliguric acute kidney injury (AKI) and was transferred to the intensive care unit (ICU) where he underwent two 0.5-volume exchange sessions of therapeutic plasma exchange (TPE) with 5% albumin. This lowered his serum TG from 5,080mg/dL to a nadir of 332mg/dL—a 93% reduction. Upon AKI resolution, the patient was discharged in stable condition and reported a TG level of 568mg/dL at his first follow-up visit (lowest value in >10 years). 

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The use of plasma exchange for HIP has been graded a 2C recommendation (weak) in the 2013 Guidelines on the use of Therapeutic Apheresis. However, over the years, evidence indicating favorable outcomes with the use of TPEs has increased. A 2015 systematic review, which included over 70 case reports, showed an average reduction of 85% in patients treated with TPE.

Findings from this case demonstrate the efficacy of TPE in lowering serum TG levels and also highlight the need to recognize TPE as a potential treatment option for moderate to severe pancreatitis. The authors added, “[g]iven this patient’s numerous admissions, this report raises a possible role for TPE in preventing readmission, long-term sequelae of pancreatitis, and other morbidities associated with the disease.”

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