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Zsíros et al. Vessel Plus 2019;3:6 I http://dx.doi.org/10.20517/2574-1209.2018.78 Page 3 of 6

Table 1. Laboratory parameters before treatment
Parameter Unit Value Reference range
Total cholesterol mmol/L 24.7 (H) < 5.2
Triglyceride mmol/L 41.00 (H) < 1.7
Apolipoprotein A g/L 1.86 > 1.15
Apolipoprotein B100 g/L 2.25 (H) < 1
Lipoprotein(a) mg/L 114 (H) < 30
sTSH mU/L 0.978 0.300-4.200
fT3 pmol/L 1.8 (L) 2.4-6.3
fT4 pmol/L 8.2 (L) 12.0-22.0
CRP mg/L 8.2 (H) < 5.2
Lipid electrophoresis
AlfaLP % 7 (L) 15-40
PreßLP % 53 (H) 2-31
BetaLP % 34 (L) 42-70
Chylomicron % 6 -

Her levels of lipase, amylase, transaminases, and inflammatory markers were in the normal range. Abdominal
ultrasound showed neither cholelithiasis nor any symptoms of pancreatitis. The development of fetus was
appropriate. The patient case was followed by obstetrician, endocrinologist, neonatologist, and dietitian.

She started on a fat-restricted diet (< 20% of total calories from fat daily) and consumed 15 g medium-chain
triglycerides and 3 g omega-3-fatty esters daily, but two days later her triglyceride level remained 41 mmol/L.
Therefore, she was immediately admitted to our ICU and we decided to perform plasmapheresis using
central veins with human albumin infusion as a colloidal solution with one plasma volume exchange and
FRESENIUS Com.tec Kabi Therapeutic Plasma Exchange machine.

There were not any complications during plasmapheresis. The patient delivered a healthy female neonate
weighing 3,150 g at 40 weeks. One day after delivery her triglyceride level was decreased to 15.68 mmol/L,
two more days later it was 7.3 mmol/L without any further plasmapheresis procedures. The alterations of
lipid parameters are shown in Figures 1 and 2.

During lactation, we suggested fat-restricted diet and regular control of triglyceride level. Gene
polymorphisms of lipoprotein lipase and Apolipoprotein E were determined. The patient has ApoE 3/3
genotype, therefore, we could exclude the familial dysbetalipoproteinemia as a possible cause. The patient is
wild type for two common polymorphisms of LPL (LPL-D9N and LPL-N291S) causing hypertriglyceridemia.
Although, there was some chylomicron increment, a significant increase in the level of VLDL determined by
lipid electrophoresis excludes the possibility of severe LPL deficiency.

DISCUSSION
In the last decades, women had increasing access to graduation in professional schools, building careers,
[15]
and using contraceptive methods worldwide . This has led to the delay of first marriage and first child
[16]
birth. In fact, the average age at first birth rose from 22.7 years in 1980 to 28.2 years in 2013 . Indeed, many
women are choosing to delay attempts to conceive to their thirties and forties, when they have a significantly
higher risk of type 2 diabetes, metabolic syndrome and other non-communicable diseases causing lipid
abnormalities. Furthermore, the proportion of women of reproductive age who are overweight or obese is
[17]
also increasing at an alarming rate . The incidence of severe hypertriglyceridemia in pregnant women
might be higher than we believe.

Although during pregnancy measurement of lipid parameters is not performed routinely, in case of a
lipemic blood sample, suggestive patient history or previous pancreatitis, determination of triglyceride level
is definitely required.