#805 Successful application of DALI for extracorporeal hemocorrection in a patient with LDL cholesterol serum levels (case study)
Authors: Amanzholova Ainamkoz , Bekishev Bolat , Jabayeva Nilufar , Koichubayeva Dariga 
Published: May 2024

Abstract

Background and Aims
Plasma lipoidosis type 4 (PLD4) is a rare hereditary disease characterized by disorders of fat metabolism in the body. PLD4 occurs rare in the general population. The exact frequency of occurrence is unknown, as it depends on hereditary factors in a particular population. The relevance of the disease lies in its rarity and potential association with various complications. Patients with PLD4 have decreased levels of low-density cholesterol (LDL) and increased levels of triglycerides in the blood, which can lead to the development of atherosclerosis and other cardiovascular diseases. Plasma lipoidosis type 4 requires further researches for better understanding of its epidemiology, mechanisms of development and possible treatment strategies.
In this case, we describe the case of a patient with type 4 plasmatic lipoidosis who was treated with the DALI (Direct Adsorption of Lipoproteins) technique.
Anticoagulation is initiated with heparin and maintained by ACT. This technique is accompanied by decreasing the level of LDL and Lp (a) without decreasing the level of HDL and fibrinogen. The pore sizes of the polyacrylamide bed are small enough to avoid the removal of red blood cells and platelets. Activation of leukocytes and complement is minimal and clinically insignificant. Depending on the initial level of lipidemia during this procedure, it is possible to select the appropriate adsorber (DALI-500, -750, -1000).
Methods of extracorporeal correction of lipid metabolism disorders should be widely introduced into healthcare practice. It should be noted that during DALI apheresis, the fibrinogen level does not decrease so sharply and is not accompanied by changes in erythrocyte aggregation. (Richter W. O., 2003).

Aim of study
The purpose of our study was to evaluate the effectiveness of using DALI (Direct Adsorption of Lipoproteins) in a patient with type 4 plasmatic lipoidosis.

Method
Patient N., 67 years old, diagnosed with IHD. Angina pectoris FC 2. Plasma lipoidosis type 4, hyperbetalipoproteinemia by autosomal dominant type of inheritance. Cysts of both kidneys. In 1997, diagnosed with: plasma lipoidosis type 4, hyperbetalipoproteinemia by an autosomal dominant type of inheritance. The plasmapheresis sessions were recommended against the increased lipid metabolism indexes. The patient regularly receives antilipidemic therapy and plasmapheresis sessions up to 2 times a year. The patient is admitted with complaints of fatigue and general weakness. According to the patient's ambulatory card, discharge summaries: CREA - 147 µmol/l, UREA – 6.3 mmol/l. GFR – 34 ml/min/1.73 m2. Total bilirubin - 9 µmol/l, direct bilirubin - 3 µmol/l. Considering the severity of the condition and the activity of the main diagnosis, a procedure with the DALI technique was started. During the hospitalization period, 3 procedures were performed, the whole of them were tolerated satisfactorily. The general condition is of moderate severity. Consciousness is clear. Hemodynamics is stable. Urination is free and painless. Diuresis is adequate.

Results
Hemodynamics: when connected - blood pressure – 120/82 mm Hg, heart rate – 61 beats/min. When disconnected, the patient's condition is the same, hemodynamics - blood pressure – 119/59 mm Hg, heart rate – 65 beats / min.

Conclusion
The usage of the apheresis method with the DALI system can effectively reduce the level of low-density lipoprotein (LDL) and Lp (a), while maintaining the content of high-density lipoprotein (HDL) and fibrinogen at a constant level. This reduction in LDL concentrations has the potential to reduce patients' risk of developing cardiovascular disease and the mortality from it.