Work

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

Year: 2026

Type: article

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.

Source: Journal of Clinical Apheresis

DOI: 10.1002/jca.70095

Authors: Catherine Bodnar, Christina Hughey, Ariel Bodker, Chinelo P. Onyenekwu

Institution: University of Wisconsin–Madison

Language: English

Topic: Blood properties and coagulation

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,920