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Page 4 of 6 Zsíros et al. Vessel Plus 2019;3:6 I http://dx.doi.org/10.20517/2574-1209.2018.78

45
Before treatment
40
After treatment
35
One day after delivery
30
25
20
15

10
5
0
Triglyceride Total cholesterol Apolipoprotein Apolipoprotein A Lipoprotein (a)
(mmol/L) (mmol/L) B100 (g/L) (g/L) (mg/dL)
Figure 1. Lipid parameters before and immediately after treatment plasmapheresis, and one day after delivery

Triglyceride Total cholesterol Apolipoprotein Apolipoprotein A Lipoprotein (a)
(mmol/L) (mmol/L) B100 (g/L) (g/L) (mg/dL)
0

-10

-20

-30

-40

-50

-60
Figure 2. Changes (%) in lipid parameters before and immediately after plasmapheresis treatment

While treatment of gestational hypertriglyceridemia-induced pancreatitis with plasmapheresis is well-
defined , the timing and frequency of plasmapheresis procedures in gestational hypertriglyceridemia
[6]
without pancreatitis should be determined individually, depending on patient’s history, symptoms, duration
of pregnancy and the lowest triglyceride level available with diet. To date, there is no available guideline for
the management of severe hypertriglyceridemia that develops during pregnancy. Although some case reports
and series were published , including treatment methods such as intravenous insulin and glucose, heparin
[12]
and apheresis, they are not comparable, therefore, the clinician has to come to the optimal decision. The
timing of the extracorporeal treatment can be an especially tender spot, since all of these procedures may
provoke adverse events such as hemodynamical instability, which can be especially critical in late pregnancy.
Early plasmapheresis as a successful treatment in hypertriglyceridemia-induced acute pancreatitis in first-
[18]
trimester pregnancy following in vitro fertilization was reported previously . Here, we present a successful
treatment in late pregnancy without adverse events.