Plasmapheresis: better late than never

Excerpt

A 21-year-old male with a history of type IV hyperlipidemia and secondary diabetes was admitted to the emergency department for acute epigastralgia. First blood analysis showed lactescent serum with a lipid layer (Fig. 1), the diagnosis of acute pancreatitis (AP) secondary to hypertriglyceridemia (HTG) was made. First measured TGs level was 15,340 mg/dL (norms 0–194 mg/dL), lipasemia was 1400 UI/L and glycemia was over 33 mmol/L. He was initially treated with an aggressive regimen of intravenous fluids, fasting and insulin therapy for 48 h. He was referred to intensive care unit with multiple organ failure (norepinephrine 3 µg/kg/min, 41 °C fever, PaO₂/FiO₂ ratio 80 and anuria). On admission, serum TG level was still 12,000 mg/dL. Plasmapheresis (1.5 plasma volume) was rapidly initiated without any adverse event. One 8-h session was enough to remove 4650 milliliters of concentrated TG (Fig. 2) and decrease blood level to 398 mg/dL. Vasopressor weaning and renal function recovery were obtained at the end of the session.

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