Usefulness of Plasma Exchange for Hypertriglyceridemia - Induced Severe Acute Pancreatitis: Report of Three Cases

Hypertriglyceridemia (HTG) is known to be a major cause of acute pancreatitis (AP). Since hyperlipidemia-induced AP may have a worse outcome, increased level of triglyceride (TG) should be immediately reduced to prevent deterioration of AP. We report three cases of HTGinduced severe acute pancreatitis (SAP) treated effectively using plasma exchange for reduction of increased TG level. According to Japanese criteria for severity assessment of AP, three patients were diagnosed as having SAP by prognostic factors and CT grade. TG levels in the three patients were increased to 1381, 3125 and 10320 mg/dL, respectively. After plasma exchange once or twice, TG levels declined to almost normal levels. In all cases, AP-induced inflammatory response was attenuated and prognostic factors were decreased. Our three cases were successfully treated in a short period during ICU stay without progress of pancreatitis. Since severe HTG, which means serum level of TG is more than 1000 mg/dL, is considered a risk for pancreatitis, it is important to reduce TG level immediately. Molecular weight of TG is 870-880 Da. However, continuous renal replacement therapy cannot remove TG because it is present in blood as a chylomicron or very low-density lipoprotein with a molecular weight of more than 50 kDa. It is thought that early interventions including plasma exchange for reduction of increased TG level might result in favorable outcome. We consider that rapid decline in increased TG levels of more than 1000 mg/dL by plasma exchange may improve pancreatitis without deterioration or recurrence.