Severe hypertriglycerdemia in pregnancy

R31 year old female presented with abdominal pain and respiratory distress in the third trimester of her second pregnancy. Her blood workup revealed a lipemic sample (Figure 1A) due to markedly elevated serum triglycerides of 8178 mg/dl (Glycerol Phosphate Oxidase method). Total cholesterol and Low Density Lipoprotein were elevated at 1701 mg/dl and 788 mg/dl respectively. There was no family history of lipid disorders. Diagnosis was consistent with gestational hypertriglyceridemia with acute pancreatitis (Serum Amylase-50 U/L, Serum Lipase- 96 U/L), though genetic tests to rule out pre-existing primary hypertriglyceridemia was not feasible. In view of the life threatening condition, she was initiated on Insulin-Dextrose infusion and offered one session of Plasma Exchange. Figures 1B and 1C depict membrane plasma separation with the obtained effluent as lipemic plasma. Her serum triglycerides showed a declining trend and was discharged in good health (serum triglycerides at discharge-651 mg/dl).

Severe hypertriglycerdemia in pregnancy

31 year old female presented with abdominal pain and respiratory distress in the third trimester of her second pregnancy. Her blood workup revealed a lipemic sample (Figure 1) due to markedly elevated serum triglycerides of 8178 mg/dl (Glycerol Phosphate Oxidase method). Total cholesterol and Low Density Lipoprotein were elevated at 1701 mg/dl and 788 mg/dl respectively. There was no family history of lipid disorders. Diagnosis was consistent with gestational hypertriglyceridemia with acute pancreatitis (Serum Amylase-50 U/L, Serum Lipase- 96 U/L), though genetic tests to rule out pre-existing primary hypertriglyceridemia was not feasible. In view of the life threatening condition, she was initiated on Insulin-Dextrose infusion and offered one session of Plasma Exchange. Figures 2,3 depict membrane plasma separation with the obtained effluent as lipemic plasma. Her serum triglycerides showed a declining trend and was discharged in good health (serum triglycerides at discharge-651 mg/dl).

Optimization of Heparin Anticoagulation during Membrane Plasma Separation

This study analyses 75 membrane plasma exchanges carried out in 18 patients where various amounts of heparin were used to define the heparin kinetic during plasma exchange and the appropriate anticoagulation. A specific assay was employed to measure heparin concentration. Our results showed that: 1) the heparin distribution volume exceeded the expected value by 10 to 25%; 2) the drug is filtered with a sieving coefficient = 1; 3) the appropriate concentration range is within 0.2 and 0.5 Ul/ml.; 4) the heparin blood levels strictly correlate with a PTT (p<0.001); 5) the individual need for heparin is related to the patient Hct (p<0.001) and plasma flow (p<0.001). Simple quidelines are provided to determine the appropriate heparin dosage in single patients.

Preclinical Evaluation of Haemosorbents

The selection of assessment procedures for the preclinical evaluation of haemosorbents and the relationship between such procedures and the intended application are exemplified by examination of the design and utilization of procedures based on the rat. Procedures are described for haemoperfusion and for membrane plasma separation followed by on-line sorbent treatment of plasma (plasma perfusion). These procedures are suitable for single or repeated use, with the animal in an unrestrained and conscious state. The relevance to the intended application is demonstrated with respect to artificial liver support by the ability of rat extracorporeal circuits to provide information on the relationship between sorbent properties and liver regeneration as determined by the proliferative response following partial hepatectomy.