(P-TA-6) Factors Affecting Triglyceride Clearance in Patients with Hypertriglyceridemia Receiving Plasmapheresis on Continuous and Intermittent Flow Apheresis Devices

Background/Case Studies: Although the ASFA categorizes acute hypertriglyceridemia as category III, many clinicians consider the early intervention by plasmapheresis necessary to rabidly lower triglycerides (TG). The use of plasma as the replacement fluid (RF) has been suggested presumably to replace the consumed lipoprotein lipase. Heparin could possibly release the endothelial lipoprotein lipase into circulation, thereby increasing TG clearance during sessions.

Study

Design/Methods: To determine the impact of RF (albumin vs FFP) and the anticoagulant (ACD-A vs heparin) on clinical efficacy of plasmapheresis, we studied patients with acute and recurrent hypertriglyceridemia , receiving plasmapheresis on the Optia device and evaluated TG levels post- sessions.
To evaluate plasmapheresis performed on continuous (Optia) vs intermittent flow centrifugal apheresis devices (Haemonetics), a prospective paired randomized comparison was conducted in 4 patients with recurrent hypertriglyceridemia with a median level of 2100 mg/dl. We evaluated the number of sessions to achieve therapeutic effects (TG < 600 mg/dl). Sessions were performed with albumin 4% and ACD-A.

Results/Findings: Twenty-seven patients with 31 episodes of hypertriglyceridemia with TG levels of 1600-7800 mg/dl, were enrolled in this study, including 23 females. Their median age was 27 years.
Percent reduction of TG correlated positively with TG levels pre-session and negatively with session time P< 0.05.
Using albumin as the RF, the number of sessions to achieve therapeutic effects with heparin in 11 episodes was significantly lower than that with citrate in 10 episodes P< 0.05.
Percent reduction of TG per session was significantly higher with heparin, when compared with citrate P< 0.05.
Six patients had their sessions with FFP, using heparin as the anticoagulant. TG levels in three patients remained high after a median of 4 sessions. When albumin was used as the RF, we observed a significant reduction in TG after one session. The other three patients needed significantly more sessions to reduce TG < 600 mg/dl, as compared with those using albumin (P < 0.05).

Compared with Haemonetics, the Optia removed the same volume of plasma in significantly less time, while processing less volume of blood and using less ACD-A P< 0.05. To achieve a therapeutic effect, more sessions were required with Haemonetics, as compared with the Optia P< 0.05.

Conclusions: It seems possible to optimize TG removal by using heparin as the anticoagulant. This process was completely safe and none of the patients experienced any side effects on Optia.
Shorter session duration was the most determinant factor for effective TG clearance. This can be offered nowadays by continuous flow centrifugal technology devices, particularly when using albumin as the RF. The albumin enables greater inlet flow rates, ultimately maximizing TG clearance, which in return can lead to fewer sessions.

Importance of research: We studied the clinical efficacy of plasmapheresis in a cohort of patients with acute and recurrent hypertriglyceridemia, evaluating factors that might influence levels of triglycerides (TG) post- sessions.
This work was done in an attempt to maximize TG removal during plasmapheresis and hence avoid detrimental complications including pancreatitis, particularly in patients with TG levels > 1000 mg/dl. This can in return lead to fewer session, achieving both therapeutic and economic benefits.