Treating hypertriglyceridemia

Conservative management in hypertriglyceridemia-associated pancreatitis

BACKGROUND

Severe hypertriglyceridemia (serum triglyceride >10 mmol L^-1 ) is implicated in ~9% of acute pancreatitis cases. Certain guidelines list severe hypertriglyceridemia as an indication for plasmapheresis.

OBJECTIVE

We assembled the natural trajectory of triglyceride levels in patients with acute pancreatitis due to severe hypertriglyceridemia who were managed conservatively without plasmapheresis to evaluate the effectiveness of this approach.

METHODS

A retrospective chart review was performed on 22 hospital admissions for acute pancreatitis episodes considered to be caused by severe hypertriglyceridemia. Patients were managed supportively, with cessation of oral intake (NPO) and intravenous hydration. Insulin infusion was used in 12 patients to manage concurrent hyperglycaemia.

RESULTS

Triglyceride levels for the group were evaluated using a mixed-effects model. The average triglyceride level fell from 45.4 mmol L^-1 on presentation to 13.3 mmol L^-1 within 48 h, corresponding to a mean 69.8% decrease. Regression analysis showed a triglyceride half-life of 30.6 h. Findings were similar for NPO-only and insulin infusion subgroups.

CONCLUSION

Patients with severe hypertriglyceridemia and acute pancreatitis can be conservatively managed safely and effectively without plasmapheresis.

Turbid plasma donations in whole blood donors: fat chance?

BACKGROUND

Blood donations resulting in "nontransparent turbid milky" plasma must be discarded. The aim of this study was to objectively determine opacity and to identify risk factors for turbid plasma donations.

STUDY DESIGN AND METHODS

This case-control study included 238 whole blood donors who provided turbid plasma (cases) and 309 random control subjects with normal plasma. Participants filled in a questionnaire regarding cardiovascular risk factors. Fat intake was assessed using a validated questionnaire. Opacity and lipids were measured. Additional data were retrieved from the blood bank information system. Mean differences and odds ratios were calculated with 95% confidence intervals.

RESULTS

Cases had a less favorable cardiovascular profile compared to control subjects. The usual intake of fat was not associated with turbid plasma donation. In a multivariate model, having dinner before donation (OR, 4.9; 95% CI, 2.2-11.1), triglyceride levels (OR, 7.1; 95% CI, 4.6-10.8), and smoking (OR(yes vs. no) , 2.5; 95% CI, 0.9-6.7; and OR(ever vs. no) , 5.7; 95% CI, 1.8-18.4) were associated with an increased risk. Opacity was clearly increased in turbid plasma. Total cholesterol levels were 0.51 (95% CI, 0.35-0.66) mmol/L and triglyceride levels 4.28 (95% CI, 3.92-4.68) mmol/L higher in cases. High-density lipoprotein cholesterol levels were 0.34 (95% CI, -0.39 to -0.30) mmol/L lower. Forty-two percent of all cases had very high triglyceride levels (≥ 5.65 mmol/L) compared to less than 1% of control subjects.

CONCLUSION

Donors who provided a turbid donation have a less favorable cardiovascular profile compared to other donors. Having dinner, high triglyceride levels, and smoking are independent risk factors for turbid plasma donations.