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

## TL;DR

This paper presents a case of severe high triglycerides causing heart symptoms and highlights plasma exchange as an effective treatment even without typical signs like pancreatitis.

## Contribution

The study emphasizes the under-recognized use of plasma exchange for hypertriglyceridemia-induced hyperviscosity without pancreatitis.

## Key findings

- Plasma exchange rapidly reduced triglyceride levels and resolved hyperviscosity symptoms in the index case.
- Published cases show consistent success of plasma exchange for hypertriglyceridemic hyperviscosity without pancreatitis.
- The paper advocates for early plasma exchange in symptomatic hyperviscosity regardless of pancreatitis presence.

## 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.