First priority is to decrease the severity of hyperchylomicronaemia

Commentary

This girl is acutely ill and in the first instance it is immaterial whether her hyperlipidaemia is primary or secondary. Her main requirement is for treatment which decreases the severity of the hyperchylomicronaemia as rapidly as possible. This is best achieved by plasma exchange using a continuous flow blood cell separator with heparin as the anticoagulant and 4.5% human albumin as the exchange medium.

Heparin has the advantages over citrate that it is not hypocalcaemic and that it releases lipoprotein lipase into …