What question did this study set out to answer?

To address the under-recognition and management of hyperviscosity syndrome caused by severe hypertriglyceridemia without pancreatitis.

February 21, 2026Open Access

Milky Plasma, Murky Diagnosis: Urgent Plasma Exchange for Severe Hypertriglyceridemia‐Induced Hyperviscosity Without Pancreatitis, but With Myocardial Infarction

CBCatherine M. BodnarUniversity of Wisconsin–Madison CHChristina M. HugheyUniversity of Wisconsin–Madison ABAriel BodkerUniversity of Wisconsin–Madison

Key Result

Therapeutic plasma exchange rapidly reduces triglycerides and resolves hyperviscosity symptoms in severe hypertriglyceridemia without pancreatitis.

Key Points

To address the under-recognition and management of hyperviscosity syndrome caused by severe hypertriglyceridemia without pancreatitis.
Described an index case with severe hypertriglyceridemia and hyperviscosity features.
Performed therapeutic plasma exchange (TPE) as the primary intervention.
Reviewed existing literature on TPE for hypertriglyceridemic hyperviscosity.
Therapeutic plasma exchange led to rapid triglyceride reduction.
Resolution of hyperviscosity symptoms was observed.
Highlighting the need for early recognition and intervention even without pancreatitis.

Structured PICO

Does therapeutic plasma exchange improve symptoms and reduce triglycerides in patients with severe hypertriglyceridemia-induced hyperviscosity presenting with acute coronary syndrome without pancreatitis?

Population

1 adult male (55 years old) with a history of renal transplant, familial hyperlipoproteinemia type V, severe hypertriglyceridemia, prior pancreatitis, pulmonary emboli, heart failure with preserved ejection fraction, and type II diabetes mellitus, presenting with acute coronary syndrome (NSTEMI) due to hyperviscosity syndrome without pancreatitis.

Intervention

Therapeutic plasma exchange (TPE) performed daily over 3 days, exchanging one plasma volume per procedure using 5% human serum albumin and fresh-frozen plasma.

Outcome

Reduction in serum triglycerides and resolution of hyperviscosity symptoms (chest pain and dyspnea).surrogate

Therapeutic plasma exchange rapidly reduces triglycerides and resolves cardiorespiratory symptoms in severe hypertriglyceridemia-induced hyperviscosity syndrome presenting as acute coronary syndrome without pancreatitis.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Severe hypertriglyceridemia can increase the risk of acute pancreatitis, but also clinically significant hyperviscosity syndrome characterized by the typical signs of neurologic and visual manifestations. Hyperviscosity syndrome is a well‐established medical emergency. However, hyperviscosity syndrome induced by hypertriglyceridemia may be under‐recognized, particularly when pancreatitis and other classical signs of hyperviscosity syndrome are absent. We describe an index case of extreme hypertriglyceridemia presenting with cardiorespiratory symptoms (chest pain and dyspnea) due to suspected hyperviscosity, but without clinical or radiographic evidence of pancreatitis, successfully treated with therapeutic plasma exchange (TPE). We then review the limited, but growing body of published case reports describing TPE for hypertriglyceridemic hyperviscosity without acute pancreatitis. Across cases, TPE reliably achieved rapid triglyceride reduction and resolution of hyperviscosity symptoms. This review highlights diagnostic challenges, therapeutic indications, and the rationale for early TPE in symptomatic hyperviscosity even when pancreatitis is not present.

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Cite This Study

Bodnar et al. (Sun,) reported a other. Therapeutic plasma exchange rapidly reduces triglycerides and resolves hyperviscosity symptoms in severe hypertriglyceridemia without pancreatitis.

synapsesocial.com/papers/69994bef873532290d020014 https://doi.org/https://doi.org/10.1002/jca.70095

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