Dhanush Hoskere, DO, Rohit Pal, DO, John Dedousis, MD, Antonios J. Tsompanidis, DO, Kovil Ramasamy, MD; Carepoint Health, Bayonne, NJ
Introduction: The use of therapeutic plasma exchange (TPE) has a weak recommendation for hypertriglyceridemia induced pancreatitis (HTGP) by the American Society of Apharesis. However, a few cases show reduced length of stay (LOS) and complications for patients who undergo TPE within 24 hours of admission. We present three cases to highlight the importance of timing of TPE for patients with HTGP.
Methods: Our first case is a 30 year old female with past medical history (PMH) of alcohol abuse presenting with 12 hours of sharp epigastric pain, nausea, and vomiting. Triglycerides (TG) were initially 4833, reducing to 1200 after administration of intravenous (IV) insulin at 36 hours from admission. Once TPE was conducted at 43 hours from admission, TG decreased to 168. IV insulin was then stopped. Patient’s course was complicated with acute respiratory distress syndrome requiring intubation, acute renal failure, systolic heart failure, and transfusion dependent anemia. Patient improved and was discharged on day 21. Our second case is a 49 year old male with PMH of type I diabetes, chronic myeloid leukemia, and alcohol abuse presenting with a 1 day history of diffuse generalized abdominal pain radiating to his back. Patient was diagnosed with euglycemic diabetic ketoacidosis and TG were elevated at 13,238. IV insulin was started and TPE was performed at 14 and 36 hours from admission. On day 3, TG were 556 with resolution of anion gap. IV insulin was stopped. Patient improved and was discharged on day 6 with a TG of 483. Our third patient is a 49 year old male with PMH of hypertension, alcohol abuse, and family history of hypercholesterolemia presenting with a 5 week history of epigastric abdominal pain and nonbloody, nonbilious vomitus. TG were 5180 and improved to 400 after TPE was performed at 8 hours and 27 hours from admission. However, TG subsequently increased to 817 and patient required IV insulin to reduce TG to 220. Patient improved and was discharged on day 6. Discussion: TPE can rapidly remove the triglycerides from the blood and has been used as an effective treatment for HTGP. General recommendations include initiating TPE within 48 hours of admission. However, a few case reports and series support starting TPE within 24 hours of admission. Although mortality was unchanged, our case series highlights the importance of TPE within 24 hours of admission as demonstrated by the increased systemic complications and LOS experienced by patient one in comparison to patients two and three.
Abdomen and Pelvis CT of Acute Peripancreatic Collection of Patient 1
Table of General Patient Information
Table of Time to Therapeutic Plasma Exchange
Disclosures: Dhanush Hoskere indicated no relevant financial relationships. Rohit Pal indicated no relevant financial relationships. John Dedousis indicated no relevant financial relationships. Antonios Tsompanidis indicated no relevant financial relationships. Kovil Ramasamy indicated no relevant financial relationships.