Endocrine Abstracts

Introduction: Plasmapheresis is an extracorporeal blood purification method that removes potentially harmful macromolecules (molecular weight L15 - 50 kDa) from the blood. Pancreatitis is a potentially fatal complication of hypertriglyceridemia. The current mainstay of treatment for hypertriglyceridemia associated with pancreatitis includes heparin, insulin and lipid-lowering agents. Experience with plasmapheresis is limited. We report here our experience of using plasmapheresis in the treatment of a patient with severe acute pancreatitis induced by major hypertriglyceridemia.

Case report: A 40-year-old female patient with no specific pathological history, including no known dyslipidemia, diabetes, thyreopathy or nephropathy. Admitted to intensive care for grade E pancreatitis, revealed by a sharp pain in the epigastric region, radiating to the back associated with nausea and vomiting, evolving 3 days prior to her admission. Clinical examination revealed a conscious patient, hypotension to 84/60 mmhg, tachycardia to 105 bpm, polypneac to 30 cpm, distended abdomen with diffuse abdominal sensibility. No cutaneous xanthoma or eruptive xanthomatosis were found. On workup: WBC: 3100 hb: 10.7 plq: 362000 Triglycerides: 21.48 g/l Total cholesterol: 3.9 g/l PT: 87% Urea: 1.34 Creatinine: 55.13 mg/l GFR calculated at 9.11 ml/mn Natremia: 124mmol/l K: 5.12 mmol/l Calcemia: 49.88 mg/l Albumin 31g/l Calcemia corrected: 60 mg/l rechecked 48 h later at 84.89 mg/l CRP: 670 mg/l lipase 31.99ui/l. Abdominal CT: grade E pancreatitis with multiple fluid collections around the pancreas and important ascite. The patient underwent 2 sessions of plasmapheresis and 2 sessions of hemodialysis. The clinical and paraclinical outcome was favorable, with a control triglyceridemia of 4.55 g/l and improvement of renal function.

Discussion and conclusion: Betteridge et al, were the first to perform apheresis to lower triglyceride concentrations in 1978. Since then, plasmapheresis has become a therapeutic tool for major hypertriglyceridemia. Studies currently available have demonstrated that apheresis treatment is effective in rapidly and significantly lowering triglyceride concentrations. Most studies have shown that plasmapheresis generally reduces triglyceride levels by 60-70% in a single session. Relief of acute pancreatitis symptoms after one to three sessions of plasmapheresis has been reported. In addition, several studies have noted that a maximum reduction in morbidity and mortality can be achieved when plasmapheresis is used as early as possible.