ABSTRACT
Background. Psychosocial consequences of COVID-19 pandemic caused multifaceted challenges in clinical and therapeutic practices. Particularly, several published reports described growth in alcohol and food addiction diseases. According to this, during the last months, we noticed an increase of cases of Acute Pancreatitis due to severe Hypertriglyceridemia (HTG-AP) requiring urgent Therapeutic Plasma Exchange (TPE), compared to the previous 10 years. Case report. Between January 2020 and February 2021, at the Therapeutic Apheresis Unit of the Padua University Hospital, we treated 6 patients with HTG-AP, of which 4 patients during the last 2 months. The total amount of HTG-AP patients treated with TPE from 2011 to 2021 is 10 (7 male and 3 female, 1 patient was treated twice). All were treated with a single session of TPE, by exchanging one total plasma volume with 2/3 4% albumin solution and 1/3 fresh frozen plasma (in one patient only albumin solution has been used). Triglycerides (TG) values before TPE were higher than 22,6 mmol/L (2.000 mg/dL) in all cases. Following a single apheresis session, within 48 hours, there were a statistically significant reduction in TG values (Figure 1, p <.0001), with an observed median value reduction of 90% (range 56-94%). Common comorbidities were alcohol abuse, hyperlipemia, obesity and diabetes mellitus. All patients recovered from HTGAP and were discharged from hospital after a mean of 12 days (range 7-21). Conclusions. The recent increase of patients with HTGAP treated with TPE seems meaningful, considering that from 2011 to 2019 we treated only 4 patients for HTG-AP, although the total number of TPE sessions has been comparable throughout this period (about 1.100 procedures per year) and however higher than overall TPE sessions performed in 2020, i.e., 822 procedures. Besides this, retrospective cohort studies have been published describing the onset of acute pancreatitis during COVID-19 infection even if, to date, there is still insufficient evidence to establish causality. Anyway, COVID-19 pandemic translated in changes of overall disease prevalence scenario and therefore it is crucial to provide a proper reorganization of the Therapeutic Apheresis activity.
ABSTRACT
INTRODUCTION: The recent Coronavirus Disease 2019 (COVID-19) outbreak has led to profound and rapid changes in the Italian and Veneto Region Healthcare System. This context also includes the quick reorganization which the Apheresis Unit (AU) of the Padova University Hospital, i.e. the Regional Reference Center for Therapeutic Apheresis (TA), had to face. MATERIAL AND METHODS: The study retrospectively evaluated the TA activity (procedures performed, patients treated and consultations) during the COVID-19 pandemic, from March to April 2020, comparing the activity in the same time period in 2018 and 2019. RESULTS: In the period analyzed, a significant reduction in both the total number of procedures performed and of patients treated, respectively by 17 % and 16 % for the procedures and by 19 % and 20 % for patients treated compared to the same period of 2018 and 2019, respectively, was observed. A concomitant reduction in requests for TA consultation for new patients (both outpatients and inpatients) was observed, equal to 32 % and 21 % compared to 2018 and 2019, respectively. CONCLUSION: Many reasons determined the observed reduction in the TA activity during the recent COVID-19 outbreak. The AU itself was quickly reorganized in terms of location and supplies to allow for the appropriate COVID-19 patients care. Many non urgent cases, after multidisciplinary discussion between Clinicians and Apheresis Specialists, were deferred, maintaining close phone and e-mail contact with patients.