Therapeutic plasma exchange rapidly reduces triglycerides and resolves hyperviscosity symptoms in severe hypertriglyceridemia without pancreatitis.
Does therapeutic plasma exchange improve symptoms and reduce triglycerides in patients with severe hypertriglyceridemia-induced hyperviscosity presenting with acute coronary syndrome without pancreatitis?
Therapeutic plasma exchange rapidly reduces triglycerides and resolves cardiorespiratory symptoms in severe hypertriglyceridemia-induced hyperviscosity syndrome presenting as acute coronary syndrome without pancreatitis.
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.
Bodnar et al. (2026) studied this question. Therapeutic plasma exchange rapidly reduces triglycerides and resolves hyperviscosity symptoms in severe hypertriglyceridemia without pancreatitis.