Safe Continuation of Apheresis during Pregnancy using the Double-Filtration Plasmapheresis Thermo Mode in a Pregnant Female with Familial Hypercholesterolemia - A Case Report

Sep 30, 2026

Familial hypercholesterolemia (FH) is an inherited disorder marked by elevated LDL cholesterol and increased risk of early atherosclerotic cardiovascular disease. In pregnant patients, lipid-lowering medication such as statins are generally contraindicated, making apheresis the preferred strategy. This case report describes a 32-year-old woman with homozygous FH who underwent different apheresis approaches across pregnancies, first using DFPP and then introducing DF-thermo to mitigate hypotension and albumin loss, supporting effective LDL control while enabling successful delivery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Introduction

Case Report

Blood Pressure Changes During Plasma Exchange

Discussion and Outcome

The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Case Report J Atheroscler Thromb, 2026; 33: 109-115. [http://doi.org/10.5551/jat.65360](http://doi.org/10.5551/jat.65360) Safe Continuation of Apheresis during Pregnancy using the Double-Filtration Plasmapheresis Thermo Mode in a Pregnant Female with Familial Hypercholesterolemia: A Case Report Yoshimasa Sakurabu 1 , Haruhito A. Uchida 1 , Yuka Okuyama 1 , Eriko Eto 2 , Kanako Takasugi 1 , Tomohiko Asakawa 1, Katsuyoshi Katayama 1, Shugo Okamoto 1, Yasuhiro Onishi 1, Natsumi Matsuoka-Uchiyama 1, Chihiro Fujihara 3 , Keiko Tanaka 1 , Hidemi Takeuchi 1 , Ryoko Umebayashi 1 , Katsuyuki Tanabe 1 and Jun Wada 1 1 Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan 2 Department of Obstetrics and Gynecology, Okayama University Hospital, Okayama, Japan 3 Department of Clinical Engineering Center, Okayama University Hospital, Okayama, Japan Familial hypercholesterolemia (FH) is an inherited disorder characterized by elevated LDL cholesterol levels and an increased risk of early-onset atherosclerotic cardiovascular disease. In pregnant female with FH, apheresisis the preferred treatment because standard therapeutic agents such as statins are contraindicated during pregnancy. LDL adsorption therapy is commonly used; however, after 27 weeks of gestation, it is often switched to dual filtration plasma exchange (DFPP) due to the significant drop in blood pressure caused by bradykinin production. However, DFPP has limited ability to adapt to the increase in circulating plasma volume associated with pregnancy. Here we discuss the case ofa 32-year-old female with homozygous FH who underwent different apheresis strategies during her pregnancies. In her first pregnancy, she continued LDL adsorption therapy using DFPP but ultimately delivered a small-for-gestational-age infant via cesarean section. For her second pregnancy, double-filtration plasmapheresis thermo mode, DF-thermo, was introduced to mitigate the limitations of DFPP and LDL adsorption therapies, such as hypotension during apheresis and albumin loss. By minimizing these complications, DF-thermo allowed for a successful delivery without compromising fetal growth. Key words: Familial hypercholesterolemia, Double-filtration plasmapheresis thermo-mode, Pregnancy | Introduction:
Familial hypercholesterolemia (FH) is a genetic disease characterized by elevated low-density lipoprotein (LDL) cholesterol concentration and early onset of atherosclerotic cardiovascular disease. Treatment of FH includes a low-fat diet and smoking cessation guidance and management of comorbidities such as diabetes and hypertension, use of statins and other medications and LDL apheresis 1) . Although most therapeutic agents such as statins are contraindicated in pregnant females with FH, with a | few exceptions, continued apheresis during pregnancy is desirable to ensure appropriate lipid management for increased cardiovascular stress due to increased blood coagulation capacity, platelet function, and blood viscosity during pregnancy 2) . Here we discuss a case in which double-filtration plasma exchange therapy (DF-thermo) was successfully applied to a pregnant patient with FH, allowing for effective LDL cholesterol management within the target range while minimizing hypotension and albumin loss. | | --- | --- | Address for correspondence: Haruhito A. Uchida, Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan. E-mail: [hauchida@okayama-u.ac.jp](hauchida@okayama-u.ac.jp) [Received: March 10](Received: March 10) , 2025 Accepted for publication: July 6, 2025 Copyright©2026 Japan Atherosclerosis Society This ar

FAQs

Why is apheresis preferred for familial hypercholesterolemia during pregnancy?

Standard lipid-lowering agents such as statins are contraindicated during pregnancy for most patients with FH. Apheresis is therefore used to maintain LDL management and reduce cardiovascular risk.

What limitation of DFPP prompted the use of DF-thermo?

After around 27 weeks of gestation, DFPP is often switched to because blood pressure can drop due to bradykinin production. DFPP also has limited ability to adapt to the increased circulating plasma volume during pregnancy.

How did DF-thermo affect pregnancy and delivery in this case?

DF-thermo was introduced in the second pregnancy to reduce complications such as hypotension and albumin loss. With these complications minimized, the patient achieved a successful delivery without compromising fetal growth.

Sep 30, 2026

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