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Archives of Gynecology and Obstetrics

, Volume 287, Issue 5, pp 839–843 | Cite as

Therapeutic apheresis for severe hypertriglyceridemia in pregnancy

  • Rafet Basar
  • Ayse Kubat UzumEmail author
  • Bulent Canbaz
  • Sema Ciftci Dogansen
  • Sevgi Kalayoglu-Besisik
  • Senem Altay-Dadin
  • Ferihan Aral
  • Nese Colak Ozbey
Maternal-Fetal Medicine

Abstract

Introduction

During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain <300 mg/dl. In women with genetic forms of hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy.

Materials and methods

We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used.

Result and conclusion

When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.

Keywords

Hypertriglyceridemia Pregnancy Acute pancreatitis Plasmapheresis Double filtration apheresis 

Notes

Conflict of interest

The authors certify that no actual or potential conflict of interest in relation to this article exists.

References

  1. 1.
    Papadakis EP, Sarigianni M, Mikhailidis DP, Mamopoulos A, Karagiannis V (2011) Acute pancreatitis in pregnancy: an overview. Eur J Obstet Gynecol Reprod Biol 159(2):261–266PubMedGoogle Scholar
  2. 2.
    Sun L, Li W, Geng Y, Shen B, Li J (2011) Acute pancreatitis in pregnancy. Acta Obstet Gynecol Scand 90:671–676PubMedCrossRefGoogle Scholar
  3. 3.
    Tsuang W, Navaneethan U, Ruiz R, Palascak JB, Gelrud A (2009) Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol 104:981–991CrossRefGoogle Scholar
  4. 4.
    Geng Y, Li W, Sun L, Tong Z, Li N, Li J (2011) Severe acute pancreatitis during pregnancy: 11 years experience from a surgical intensive care unit. Dig Dis Sci 56(12):3672–3677PubMedCrossRefGoogle Scholar
  5. 5.
    Syed H, Bilusic M, Rhondla C, Tavaria A (2010) Plasmapheresis in the hypertriglyceridemia-induced acute pancreatitis: a community hospital’s experience. J Clin Apher 25:229–234PubMedCrossRefGoogle Scholar
  6. 6.
    Piolot A, Nadler F, Cavallero E, Coquard J-L, Jacotot B (1996) Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia: value of regular plasmapheresis. Pancreas 13:96–99PubMedCrossRefGoogle Scholar
  7. 7.
    Saharia P, Margolis S, Zuidema GD, Cameron JL (1977) Acute pancreatitis with hyperlipidemia: studies with an isolated perfused canine pancreas. Surgery 82:60–67PubMedGoogle Scholar
  8. 8.
    Ewald N, Kloer H-U (2009) Severe hypertriglyceridemia: an indication for apheresis. Atheroscler Suppl 10:49–52PubMedCrossRefGoogle Scholar
  9. 9.
    Thompson GR (2010) Lipoprotein apheresis. Curr Opin Lipidol 21:487–491PubMedCrossRefGoogle Scholar
  10. 10.
    Goldberg AS, Hegele RA (2012) Severe hypertriglyceridemia in pregnancy. J Clin Endocrinol Metab 97:2589–2597PubMedCrossRefGoogle Scholar
  11. 11.
    Yuan G, Al-Shali KZ, Hegele RA (2007) Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 176:1113–1120PubMedCrossRefGoogle Scholar
  12. 12.
    Potter JM, Nestel PJ (1979) The hyperlipidemia of pregnancy in normal and complicated pregnancies. Am J Obstet Gynecol 133:165–170PubMedGoogle Scholar
  13. 13.
    Szczepiorkowski ZM, Winters SL, Bandarenko N, Kim HC, Linenberger ML, Marques BM, Sarode R, Schwarts J, Weinstein R, Shaz BH (2010) Apheresis Application Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice. Evidence based approach from the Apheresis Applications Committee of American Society for Apheresis. J Clin Apher 25:83–177PubMedCrossRefGoogle Scholar
  14. 14.
    Hovland A, Hardersen R, Mollnes TE, Lappegard TE (2010) Selective whole blood lipoprotein apheresis to prevent pancreatitis in drug refractory hypertriglyceridemia. JOP 11:467–469PubMedGoogle Scholar
  15. 15.
    Safi F, Toumeh A, Abuissa Qadan MA, Karaz R, Alakdar B, Assaly R (2012). Management of familial hypertriglyceridemia-induced pancreatitis during pregnancy with therapeutic plasma exchange: a case report and review of literature. Am J Ther (Epub ahead of print)Google Scholar
  16. 16.
    Toskes PP (1990) Hyperlipidemic pancreatitis. Gastroenterol Clin North Am 19:783–791PubMedGoogle Scholar
  17. 17.
    Leaf DA (2008) Chylomicronemia and chylomicronemia syndrome: a practical approach to management. Am J Med 121:10–12PubMedCrossRefGoogle Scholar
  18. 18.
    Lone SW, Imdad A, Billoo AG (2008) Familial chylomicronemia in a 9 months old infant. J Coll Physicians Surg Pak 18:655–656PubMedGoogle Scholar
  19. 19.
    Kwan HC, Bongu A (1999) The hyperviscosity syndromes. Semin Thromb Hemost 25:199–208CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rafet Basar
    • 1
  • Ayse Kubat Uzum
    • 2
    Email author
  • Bulent Canbaz
    • 2
  • Sema Ciftci Dogansen
    • 2
  • Sevgi Kalayoglu-Besisik
    • 3
  • Senem Altay-Dadin
    • 3
  • Ferihan Aral
    • 2
  • Nese Colak Ozbey
    • 2
  1. 1.Department of Internal MedicineIstanbul University, Istanbul Medical FacultyIstanbulTurkey
  2. 2.Division of Endocrinology, Department of Internal MedicineIstanbul University, Istanbul Medical FacultyIstanbulTurkey
  3. 3.Division of Hematology, Department of Internal MedicineIstanbul University, Istanbul Medical FacultyIstanbulTurkey

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