BENGALURU, India, Jan. 25, 2023 /PRNewswire/ --  A 34 year old Suma (name changed), diagnosed with Homozygous Familial Hypercholesterolemia (HoFH) since 2014 was referred to Manipal Hospital, Old Airport Road, Bengaluru. HoFH is a condition where two abnormal genes one from each parent is inherited by the patient. This leads to very high levels of bad cholesterol which deposits in the blood vessels leading to heart disease and premature death. Our patient too developed cardiac symptoms and was referred to Dr. Devananda N S, Head & Consultant – Cardiothoracic Vascular Surgery and Lung Transplant Surgery, Manipal Hospital Old Airport Road, Bengaluru for bypass surgery of the heart in 2021.

Following the surgery she was referred to Dr. WG CDR S.S. Iyengar, Consultant - Cardiologist, Manipal Hospital Old Airport Road for further management and was treated with statins and lipid lowering agents. She had suffered a miscarriage at 7-8 weeks gestation during her first pregnancy in 2018. She conceived again for the second time in early 2022. In view of the high risk pregnancy, the lack of efficacy and inability to use some drugs in pregnancy, lipoprotein apheresis procedure was considered by Dr. S.S. Iyengar and the patient referred to Transfusion Medicine department.

Lipoporotein apheresis is a procedure akin to dialysis, where the patient's blood is passed through a cascade filter which removes the bad cholesterol and returns the filtered blood (plasma) back to the patient. Since production of cholesterol in the body is a continuous process the procedure has to be repeated fortnightly to keep the cholesterol levels under check. A total of 5 procedures each costing approximately Rs 75,000/- per session were done free of cost to the patient starting from 22 weeks owing to the support from the Manipal Hospital Management and Lipid Association of India who sponsored the drugs free of cost. In view of the cost constraints the procedures were spaced at 1 month intervals until delivery.

Vascular access for the procedure was secured with the help of Dr. Sridhara G, Consultant - Interventional Cardiology, cardiac Electrophysiology and the procedures carried out by Dr. C. Shivaram, Consultant & Head – Transfusion Medicine, and Dr Ambuja K, Associate Consultant - Transfusion Medicine.  

Fetal monitoring during procedure and obstetrical care was provided by Dr. Gayathri Karthik Nagesh, HOD & Cosultant – Obstetrics & Gynaecology. A healthy baby was delivered at term, by caesarean section on 6^thJan 2023 and both mother and child are doing well. Neonatal care was provided by Dr. Karthik Nagesh, Chairman & HOD, Neonatal ICU and Manipal Advanced Children's Centre.

But for the efforts of Dr. S.S.  Iyengar, the primary physician who cared for this patient from end-end, this baby would not have seen the light of the day. Lipid apheresis is a very rare procedure and to the best our knowledge Manipal Hospital, Old Airport Road, Benglauru is the first to do this in pregnancy in the country. In all lipoprotein apheresis procedures the cost of the filter which is as expensive as Rs 50,000/- and plasmapheresis which cost about Rs 10,000/- are the limiting factors. Most of these patients cannot afford the filter and need help from government and philanthropic organizations.

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