Prevention of Recurrent Acute Pancreatitis in Patients with Severe Hypertriglyceridemia: Value of Regular Plasmapheresis

Summary: The association between acute pancreatitis and severe hypertriglyceridemia has long been recog-nized. We report two cases of severe primary hypertrig-lyceridemia (types 1 and V) with recurrent acute pancre-atitis. In both patients, observance of appropriate diet and drug therapy was insufficient. Recurrent episodes of pancreatitis were precipitated by dietary fat or alcohol abuse. A plasmapheresis was performed every 4 weeks to decrease the incidence of pancreatitis. It appears that plasmapheresis is a safe and highly effective method for quickly removing serum triglycerides. Moreover, plasma-pheresis may be useful for preventing acute pancreatitis. Key Words: Acute pancreatitis-Hypertriglyceridemia-Plasmapheresis. Pancreatitis is a well-known complication of se-vere primary and secondary hypertriglyceridemia ( 1 1. Types I, IV, and V hyperlipoproteinemias (ex-ogenous, endogenous, and mixed hyperlipopro-teineniia, respectively) are risk factors for the de-velopment of pancreatitis (2). Patients with triglyc-eride levels of 3 1 I.3 mM ( 1000 mg/dl) are at high risk for acute pancreatitis (3,4). Before any patient with hyperlipidemia is committed to therapy, poten-tial causes of secondary hyperlipidemia should be ascertained and treated. Dietary management is al-ways the first step in treatment of hypertriglyceri-demia, especially in patients with obesity, alcohol-ism, or poorly controlled diabetes mellitus. In type I, restriction of dietary fat to ~ 2 0 giday is usually sufficient to reduce plasma triglyceride levels. If ap-propriate diet cannot be sufficient, a drug therapy should be associated in types 1V and V (5,6). Rarely, triglyceride levels of a primary hypertri-Manuscript received February 21, 1995; revised manuscrip