The review of hypertriglyceridemia by George Yuan and colleagues was quite interesting. We would like to highlight plasma exchange as another therapeutic option for this condition.1 Plasma exchange is used to treat a broad spectrum of conditions, and it can serve either as a primary or as an adjunct therapy. Familial hypertriglyceridemia is a category I indication for plasma exchange, as defined by the American Society for Apheresis.2 Hypercholesterolemia and hypertriglyceridemia are the most common indications for plasma exchange in European countries.3 In some reports, plasma exchange has been found to be useful particularly in patients who are pregnant, who have severe hypertriglyceridemia, who have acute and recurrent pancreatitis with hypertriglyceridemia or who do not respond to other forms of treatment.
Plasma exchange may reduce triglyceride levels and remove circulating activated enzymes and inflammatory mediators.4,5 We evaluated the effectiveness of plasma exchange in 7 patients with severe hypertriglyceridemia. Triglyeride and total cholesterol levels were reduced by 46.1% and 50.8%, respectively, and the patients tolerated the therapy well.6
Although the evidence to date is limited, plasma exchange may be used safely and effectively in patients with severe hyperlipidemia who are at risk of acute coronary events and acute pancreatitis.
Footnotes
Competing interests: None declared.
REFERENCES
- 1.Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113-20. [DOI] [PMC free article] [PubMed]
- 2.Leitman SF, Ciaverella D, McLeod B, et al. Guidelines for therapeutic hemapheresis. Bethesda (MD): American Association of Blood Banks; 1994.
- 3.Jones HG, Bandarenko N. Management of the therapeutic apheresis patient. In: McLeod B, Price TH, Weinstein R, editors. Apheresis: principles and practice. 2nd ed. Bethesda (MD): American Association of Blood Banks Press; 2003. p. 253-74.
- 4.Heinisch A, Balle C, Kadow R. Plasmapheresis in severe acute pancreatitis: A new therapeutic option? Gastroenterology 1995;108:359.
- 5.Chen JH, Yeh JH, Lai HW, et al. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol 2004;10:2272-4. [DOI] [PMC free article] [PubMed]
- 6.Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia: a clinical study. Transfus Apher Sci 2006;34:253-7. [DOI] [PubMed]