Abstract：
BACKGROUND: Pregnant patients with a history of hypertriglyceridemia are at increased risk for development of acute pancreatitis. When conservative management fails to maintain triglyceride levels less than 250-500 mg dL-1 , implementation of pregnancy category C medications to prevent pancreatitis must be considered. Plasmapheresis rapidly reduces triglyceride levels and has been reported as a successful third-line therapy for hypertriglyceridemia-induced acute pancreatitis in a limited number of pregnant patients. Use of preventative plasmapheresis as a bridge to delivery is not well characterised.
METHODS: We report an outpatient plasmapheresis regimen for the control of hypertriglyceridemia in a pregnant patient with a history of diabetes mellitus, hypertriglyceridemia, distal pancreatectomy, and repeat pregnancy loss. During the second trimester, refractory triglyceride levels increased up to 3438 mg dL-1 by 28 weeks gestation. Given the patient\'s high risk for recurrent pancreatitis and limited remaining pancreatic parenchyma, she was treated acutely with two single-plasma-volume exchanges with 100% albumin over 2 days, decreasing the triglyceride level to 559 mg dL-1 . Subsequent plasmapheresis every 7 to 9 days maintained a triglyceride level of 320-1296 mg dL-1 . The patient experienced no adverse effects and remained outpatient until successful scheduled delivery for hypertension at 33 weeks gestation.
CONCLUSIONS: For select patients, early escalation to plasmapheresis may prevent morbidity and mortality associated with acute pancreatitis. An individualised plasmapheresis regimen can serve as a bridge to delivery, which requires close observation and the coordination of a multidisciplinary team.
METHODS: We report an outpatient plasmapheresis regimen for the control of hypertriglyceridemia in a pregnant patient with a history of diabetes mellitus, hypertriglyceridemia, distal pancreatectomy, and repeat pregnancy loss. During the second trimester, refractory triglyceride levels increased up to 3438 mg dL-1 by 28 weeks gestation. Given the patient\'s high risk for recurrent pancreatitis and limited remaining pancreatic parenchyma, she was treated acutely with two single-plasma-volume exchanges with 100% albumin over 2 days, decreasing the triglyceride level to 559 mg dL-1 . Subsequent plasmapheresis every 7 to 9 days maintained a triglyceride level of 320-1296 mg dL-1 . The patient experienced no adverse effects and remained outpatient until successful scheduled delivery for hypertension at 33 weeks gestation.
CONCLUSIONS: For select patients, early escalation to plasmapheresis may prevent morbidity and mortality associated with acute pancreatitis. An individualised plasmapheresis regimen can serve as a bridge to delivery, which requires close observation and the coordination of a multidisciplinary team.
摘要：
背景：有高甘油三酯血症病史的孕妇发生急性胰腺炎的风险增加。当保守管理未能维持甘油三酯水平低于250-500mgdL-1时，必须考虑实施妊娠C类药物预防胰腺炎.血浆置换可迅速降低甘油三酯水平，并已被报道为在有限数量的孕妇中成功治疗高甘油三酯血症诱导的急性胰腺炎的三线疗法。预防性血浆去除术作为递送的桥梁的用途没有得到很好的表征。
方法：我们报告了一名有糖尿病病史的妊娠患者的门诊血浆置换方案，用于控制高甘油三酯血症，高甘油三酯血症,远端胰腺切除术,重复怀孕失败。在妊娠中期，到妊娠28周时，难治性甘油三酯水平增加至3438mgdL-1。鉴于患者的复发性胰腺炎的高风险和有限的剩余胰腺实质，她在2天内接受了两次单次血浆容量置换和100%白蛋白的急性治疗，将甘油三酯水平降低至559mgdL-1。随后每7至9天血浆置换维持320-1296mgdL-1的甘油三酯水平。患者没有经历不良反应，并且在妊娠33周时因高血压成功计划分娩之前一直门诊。
结论：对于选定的患者，早期增加血浆置换可以预防急性胰腺炎的发病率和死亡率.个性化的血浆置换方案可以作为分娩的桥梁，这需要多学科小组的密切观察和协调。
方法：我们报告了一名有糖尿病病史的妊娠患者的门诊血浆置换方案，用于控制高甘油三酯血症，高甘油三酯血症,远端胰腺切除术,重复怀孕失败。在妊娠中期，到妊娠28周时，难治性甘油三酯水平增加至3438mgdL-1。鉴于患者的复发性胰腺炎的高风险和有限的剩余胰腺实质，她在2天内接受了两次单次血浆容量置换和100%白蛋白的急性治疗，将甘油三酯水平降低至559mgdL-1。随后每7至9天血浆置换维持320-1296mgdL-1的甘油三酯水平。患者没有经历不良反应，并且在妊娠33周时因高血压成功计划分娩之前一直门诊。
结论：对于选定的患者，早期增加血浆置换可以预防急性胰腺炎的发病率和死亡率.个性化的血浆置换方案可以作为分娩的桥梁，这需要多学科小组的密切观察和协调。
