Successful application of LDL (low density lipoprotein) apheresis for a pregnant woman with hypertriglyceridemia-induced acute pancreatitis

• Published in: Journal of the Japanese Society of Intensive Care Medicine Vol. 24; no. 1; pp. 26 - 30
• Main Authors: Sakura, Takanobu, Shimizu, Kazuyoshi, Hiroi, Kazumasa, Suzuki, Satoshi, Hayashi, Masao, Kaku, Ryuji, Morimatsu, Hiroshi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Intensive Care Medicine 01.01.2017
• Subjects: hypertriglyceridemia-induced acute pancreatitis; LDL (low density lipoprotein) apheresis; pregnancy
• ISSN: 1340-7988; 1882-966X
• DOI: 10.3918/jsicm.24_26

A 35-year-old pregnant woman was referred to our hospital with suspected acute pancreatitis at 39 weeks of gestation. On admission, serum triglyceride (TG) level was 11,936 mg/dl and abdominal dynamic CT revealed severe acute pancreatitis. In order to avoid further progression of hypertriglyceridemia and acute pancreatitis, a cesarean section was performed. We then performed low density lipoprotein (LDL) apheresis for the hypertriglyceridemia with consideration of safety. After three cycles of LDL apheresis, serum TG level declined to 1,764 mg/dl. On the 15th day of hospitalization, she was discharged from our hospital without any complications. Treatment of hypertriglyceridemia, including plasma apheresis and heparin-insulin therapy, is important in addition to treatment of acute pancreatitis to reduce the risk of exacerbation of acute pancreatitis in hypertriglyceridemia-induced acute pancreatitis (HIAP). LDL apheresis would be safer than plasma exchange in terms of electrolyte disturbance and transfusion-related complication. LDL apheresis might be effective for patients with HIAP.