Platelet Function and Lipoprotein Levels after Plasma-Exchange in Patients with Familial Hypercholesterolaemia

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Abstract
Repeated plasma exchange was carried out on 3 young patients with severe familial hypercholesterolemia. There was a 3 wk interval between each exchange. After a single exchange, plasma cholesterol, apolipoprotein B [apo B] and low density lipoprotein[LDL]-cholesterol levels decreased markedly, but pre-exchange levels were not achieved within 2 wk. High density lipoprotein-cholesterol and apo A-I levels also fell but returned to the original concentration after only 5 days. Platelet aggregation and [14C]serotonin release were increased in all 3 patients and dropped by 20% and 13%, respectively, after a single plasma exchange. Platelet function in vitro returned to pre-exchange levels with similar kinetics to that observed with the LDL concentration. On removal of 100 g of plasma cholesterol, after repeated exchanges, LDL concentration and platelet function were significantly decreased in comparison with values before initiation of plasma exchange. In addition there was a marked regression of xanthoma in all 3 patients. Since this procedure is instrumental in achieving a negative cholesterol balance as well as inhibiting hypersensitive platelets, it may well result in a downgrading of the atherosclerotic risk.