Plasmapheresis in the Treatment of Pancreatitis


  • Voinov V.A. I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
  • Kovalev M.G. I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.
  • Voinova Ya.V. I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.


acute pancreatitis, chronic pancreatitis, toxemia, extracorporeal detoxification, Plasmapheresis.


The incidence of pancreatitis continues to rise, remaining one of the most common causes of hospitalization among gastrointestinal diseases. Despite the improvement of medical care, severe forms of acute pancreatitis are accompanied by a high mortality rate up to 30%. This is largely determined by increasing toxemia, which requires methods of apheresis therapy and extracorporeal detoxification. With the help of plasmapheresis, it is possible to interrupt the dramatic scenario of the disease and achieve a more complete recovery. In chronic forms of pancreatitis, plasmapheresis is also indicated, especially in cases of its autoimmune etiology and hyperlipidemia.


Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet 2015; 386(9988):85-96.

James TW, Crockett SD. Management of acute pancreatitis in the first 72 hours. Curr Opin Gastroenterol 2018;34(5):330-335.

Lee P.J., Papachristou G.I. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol 2019;16(8):479-496.

Greenberg JA, Hsu J, Bawazeer M et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg 2016;59(2):128-40.

Restrepo R, Hagerott HE, Kulkarni S et al. Acute Pancreatitis in Pediatric Patients: Demographics, Etiology, and Diagnostic Imaging. AJR Am J Roentgenol 2016;2016 (3):632-44.

Cruciat G, Nemeti G, Goidescu I at al. Hypertriglyceridemia triggered acute pancreatitis in pregnancy - diagnostic approach, management and follow-up care. Lipids Health Dis 2020;19(1):2.

Waller A, Long B, Koyfman A, Gottlieb M. Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med 2018;55(6):769-779.

Garg PK, Singh VP. Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology 2019;156(7):2008-2023.

Sepúlveda EVF, Guerrero-Lozano R. Acute pancreatitis and recurrent acute pancreatitis: an exploration of clinical and etiologic factors and outcomes. J Pediatr (Rio J) 2019;95(6):713-719.

Machicado JD, Yadav D. Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences. Dig Dis Sci 2017;62(7):1683-1691.

Polishchuk I, Halperin D, Algedafy A et al. Epidemiology of Acute Pancreatitis in Southern Israel: A Retrospective Study. Isr Med Assoc J 2020;22(5):310-314.

Majumder S, Takahashi N, Chari ST. Autoimmune Pancreatitis. Dig Dis Sci 2017;62(7):1762-1769.

Khandelwal A, Inoue D, Takahashi N. Autoimmune pancreatitis: an update. Abdom Radiol (NY) 2020;45(5):1359-1370.

Munsell MA, Buscaglia JM. Acute pancreatitis. J Hosp Med 2010;5(4):241-50.

Elder ASF, Saccone GTP, Dixon D-L. Lung injury in acute pancreatitis: mechanisms underlying augmented secondary injury. Pancreatology 2012;12(1):49-56.

Yokoe M, Takada T, Mayumi T et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci 2015;22(6):405-32.

Hines OJ, Pandol SJ. Management of severe acute pancreatitis. BMJ 2019;367:l6227.

Dianliang Z, Jieshou L, Zhiwei J, Baojun Y. Association of plasma levels of tumor necrosis factor (TNF)-alpha and its soluble receptors, two polymorphisms of the TNF gene, with acute severe pancreatitis and early septic shock due to it. Pancreas 2003;26(4):339-43.

Munsell MA, Buscaglia JM. Acute pancreatitis. J Hosp Med 2010;5(4):241-50.

Voinov VA. Plasmapheresis in the treatment of acute pancreatitis. Efferentnaja Fisicochimichescaja Terapia (Moscow) 2012; 2: 14-16.

Krasnorogov V.B., Mosyagin V.B., Smelyansky A.I., Rostovsky A.B. Proactive tactics of treatment of severe forms of acute pancreatitis // Ministrу of Health of Russia, Method. recommendations. - SPb., 1998 .-- 27 p.

Hendel L.L., Cholaria N.Kh., Gubanova S.I. The value of methods of extracorporeal hemocorrection in the complex treatment of patients with acute pancreatitis // Efferentnaja therapia (Rus). - 2003. - Vol.9, No. 1. - P. 67-68.

Larvin M, Lansdown MR, McMahon MJ et al. Plasmapheresis and fulminant acute pancreatitis? BMJ 1988;297(6659):1332.

Bukaev O.B., Tishkov E.A., Aronov B.Z. et al. Efferent therapy in acute pancreatitis // Efferentnaja therapia (Rus), 2003, 9, 1, 61-62.

Borovkova N.V., Aleksandrova I.V., Rey S.I. et al. Dead leukocytes and the possibility of their elimination by methods of extracorporeal hemocorrection in patients with acute pancreatitis // In “Actual problems of hemapheresis, surgical hemocorrection and dialysis”. - Moscow, 2009, S, 7.

Kirkovsky V.V. Physicochemical methods of homeostasis correction // Moscow: "Russian Doctor". - 2012 .-- 216 p.

Nasa P, Alexander G, Kulkarni A et al. Early plasmapheresis in patients with severe hypertriglyceridemia induced acute pancreatitis. Indian J Crit Care Med. 2015 Aug;19(8):487-9.

Joglekar K, Brannick B, Kadaria D, Sodhi A. Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis: case series and review of the literature. Ther Adv Endocrinol Metab 2017;8(4):59-65.

Uyar S, Harmandar F, Kök M et al. Management of hypertriglyceridemia induced acute pancreatitis and therapeutic plasmapheresis : Report of nine cases and review of literature. Acta Gastroenterol Belg 2017;80(1):71-74.

Zhang D-L, Zheng H-M, Yu B-J et al. Association of polymorphisms of IL and CD14 genes with acute severe pancreatitis and septic shock. World J Gastroenterol 2005;11(28):4409-13.

Galán Carrillo IG, Demelo-Rodriguez P, Rodríguez Ferrero ML, Anaya F. Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia. J Clin Lipidol 2015;9(5):698-702.

Saleh MA, Mansoor E, Cooper GS. Case of familial hyperlipoproteinemia type III hypertriglyceridemia induced acute pancreatitis: Role for outpatient apheresis maintenance therapy. World J Gastroenterol. 2017 Oct 28;23(40): 7332-7336.

Lutfi R, Huang J, Wong HR. Plasmapheresis to treat hypertriglyceridemia in a child with diabetic ketoacidosis and pancreatitis. Pediatrics. 2012 Jan;129(1):e195-8.

Tominaga N, Takahira S, Taguchi T et al. Acute pancreatitis associated with systemic lupus erythematosus: Successful treatment with plasmapheresis followed by aggressive immunosuppressive therapy. Pediatr Int. 2008 Feb;50(1):109-11.

Chang HH, Chen ML, Chang CC. Acute pancreatitis preceding an acute episode of thrombotic microangiopathy. Clin Nephrol. 2010 Mar;73(3):244-6.

Altun D, Eren G, Cukurova Z, Hergünsel O, Yasar L. An alternative treatment in hypertriglyceridemia-induced acute pancreatitis in pregnancy: Plasmapheresis. J Anaesthesiol Clin Pharmacol 2012;28(2):252-4.

Gardner TB, Levy MJ, Takahashi N et al. Misdiagnosis of autoimmune pancreatitis: a caution to clinicians. Am J Gastroenterol. 2009 Jul;104(7):1620-3.

Maher NG, Ramaswamykanive H. Use of plasmapheresis in managing the diagnostic dilemma of symptomatic hypertriglyceridemia. Case Rep Gastrointest Med. 2012;2012: 501373.






Mini Review