Baylor University Medical Center Proceedings July 2017 - 358

Plasmapheresis for recurrent acute pancreatitis from
hypertriglyceridemia
Kathleen Kopecky, MD, Amber Moreland, MD, Christopher Hebert, MD, and Gates B. Colbert, MD

Acute pancreatitis is a known complication of severe hypertriglyceridemia.
Therapeutic experience with plasmapheresis is less well reported but has
been highly successful in life-threatening presentations. We describe
a 38-year-old obese Hispanic woman with a previous history of acute
pancreatitis from diabetic hypertriglyceridemia who presented to the
emergency department with a 2-day history of worsening abdominal
pain. Plasmapheresis was initiated with one calculated plasma volume
exchange using 5% albumin replacement within 24 hours of admission.
Following this treatment, the triglyceride level fell 74%. Another session
was performed the following day. The final triglyceride level represented
a 93% reduction. This case is novel in that the patient presented twice
within the same year with hypertriglyceridemic pancreatitis and responded well to prompt plasmapheresis therapy.

cute pancreatitis from hypertriglyceridemia is a rare
but well-known condition. Elevated triglycerides result
from a variety of compounding conditions that lead
to direct damage of pancreatic endocrine and exocrine
function and can cause severe ischemia to major organ systems.
Treatment of hypertriglyceridemic pancreatitis (HTGP) with
plasmapheresis is an extremely eﬀective therapy, but is less well
reported.
CASE PRESENTATION
A 38-year-old obese Hispanic woman with diabetes mellitus type 2, hyperlipidemia, and acute pancreatitis secondary
to hypertriglyceridemia presented to the emergency department
with a 2-day history of worsening abdominal pain. Ten months
earlier, the patient was admitted for acute pancreatitis secondary to hypertriglyceridemia; laboratory results are shown in
Table 1. The hospital course was complicated by altered mental
status, hypoxemic respiratory failure, and respiratory mechanical support. She underwent two plasmapheresis treatments that
quickly lowered her triglyceride level from >4000 mg/dL to normal range. Once stabilized, she was discharged and prescribed
triglyceride- and lipid-lowering medications.
On the second admission, the patient recalled eating a meal
the day of presentation and suddenly developing sharp epigastric
abdominal pain with radiation to her back. Nausea followed
with several episodes of nonbilious, nonbloody emesis. The pa-

358

Table 1. Pertinent serum laboratory values in the
patient described
10 months
earlier

Variables

Current
admission

Total cholesterol (mg/dL)

>1000

706

Triglycerides (mg/dL)

>4000

High-density lipoprotein (mg/dL)
Low-density lipoprotein (mg/dL)
Lipase (U/L)
Glucose (mg/dL)
Blood urea nitrogen (mg/dL)

492

19,536

8263

256

276

16.2

16.6

Oxygen (%)

Corrected calcium (for albumin, mg/dL)

5.9

8.2

White blood cells (K/μL)

tient had lapsed in taking her previously prescribed medications.
She denied any fever, chills, chest pain, dyspnea, or diarrhea.
In the emergency department, she appeared uncomfortable,
with cardiac examination revealing tachycardia and tachypnea.
Her abdomen was tender to palpation in the epigastric region
with guarding, but there was no palpable hepatosplenomegaly.
She had 2+ lower extremity edema but no rash. Admission vital
signs showed a blood pressure of 104/72 mm Hg, heart rate
of 104 beats per minute, temperature of 98.1°F, respiration of
18 breaths per minute, and body mass index of 39.8 kg/m2.
Laboratory tests are shown in Table 1; other pertinent results
included serum sodium, 139 mEq/L; potassium, 4.3 mEq/L;
bicarbonate, 12 mEq/L; glucose, 276 mg/dL; anion gap, 11; and
creatinine, 0.8 mg/dL. Computed tomography of the abdomen
and pelvis revealed acute pancreatitis with moderate inﬂammatory stranding predominantly surrounding the head and body
of the pancreas, but without overt pancreatic necrosis. After
From the Department of Internal Medicine, Baylor University Medical Center,
Dallas, Texas.
Corresponding author: Gates B. Colbert, MD, 3417 Gaston Avenue, Suite 875,
Dallas, TX 75246 (e-mail: Gates.Colbert@BSWHealth.org; Twitter handle:
@DoctorGates).
Proc (Bayl Univ Med Cent) 2017;30(3):358-359

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