Background. Elevated blood cholesterol, triacylglycerols and very low density lipoprotein cholesterol concentration is a characteristic finding in Fredrickson type V hyperlipoproteinemia. It is a very serious condition during pregnancy. An immediate treatment is required to prevent severe complications. Standard lipid-lowering drugs are contraindicated, thus lipoprotein plasmapheresis remains alternative effective treatment.
Aim. The aim of the study was to report a case of severe type V hyperlipoproteinemia during pregnancy and to present a literature review.
Material and methods. We did a literature review and retrospectively analysed medical documentation of a patient with severe hyperlipoproteinemia in pregnancy who had been treated in Vilnius University Hospital “Santariskiu Klinikos”.
Results. A 26-year-old pregnant woman came to the Department of obstetrics and gynaecology because of highly elevated blood serum lipid concentration. Even though the patient had not complained about her health condition, 4.7 times higher blood serum total cholesterol and 45.5 times higher serum triacylglycerols levels were found. Lipoprotein electrophoresis showed typical view of type V hyperlipoproteinemia: visable fractions of chylomicrons and pre-beta-lipoproteins. An electrocardiogram and a veloergometry test revealed a subendocardial ischaemia, while no fetal anomal ies were observed during an ultrasound examination. In order to avoid an acute pancreatitis and cardiovascular events, plasmapheresis was considered to be the most appropriate treatment. 20 sessions of plasmapheresis were successfully performed, reducing the extremely high lipid concentrations and leading to a spontaneous delivery of a healthy newborn at 39 weeks of gestation.
Conclusions. Type V hyperlipoproteinemia is a rare but very serious condition, which may progress without any evident clinical symptoms, but can be accurately diagnosed due to specific laboratory findings. The disease increases morbidity of mother and fetus. Plasmapheresis is a safe and effective alternative to pharmaceutical treatment, which has its restrictions during pregnancy.
