Antithrombin III in &lt;i&gt;Echis&lt;/i&gt;&lt;i&gt;carinatus&lt;/i&gt; Envenomation in Northern Nigeria

Gc, Onyemelukwe

doi:10.1159/000205534

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…(ref. 10 ). Similarly, normal PLT levels during the envenomation displayed evidence of the prevailing influence of PLT aggregation-inhibiting components.…”

Section: Discussionmentioning

confidence: 99%

Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Valenta¹,

Stach²,

Otáhal³

2012

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. This case report presents envenoming by the Chinese pit viper Protobothrops mangshanensis (formerly Zhaoermia) and its treatment. Methods. A 38 year old snake breeder suffered two-fang bites to elbow by a Chinese pit viper Protobothrops mangshanensis resulting in local edema of the affected arm. No other signs of envenoming appeared. On the 5 th day following the bite a hematoma developed on the other arm which had been mechanically injured 14 days before. Laboratory testing revealed severe coagulopathy with hypofibrinogenemia and immeasurably prolonged coagulation times. Results. As substitution therapy with fibrinogen and fresh frozen plasma was unsuccessful and specific antivenom is not produced, antivenin against some other Asian pit vipers GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand was applied. Three doses of antivenom reversed the course of the hemocoagulation disorder. Conclusion. The case confirms the persistence of active venom components affecting coagulation, difficulty in ameliorating the hemocoagulatin disorder caused by snake venom through substitution therapy and the effectiveness of delayed treatment using antivenin. It points out the potential risk of a clinically asymptomatic progress of envenoming by snake venoms containing hemocoagulation acting components, if the hemocoagulation disorder is not investigated and suitably treated. Therapy using the GREEN PIT VIPER ANTIVENIN, Thai Red Cross, Thailand in this case of envenomation by a Protobothrops mangshanensis bite proved to be applicable and the antivenom could be characterised as a paraspecific active.

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“…(ref. 10 ). Similarly, normal PLT levels during the envenomation displayed evidence of the prevailing influence of PLT aggregation-inhibiting components.…”

Section: Discussionmentioning

confidence: 99%

Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Valenta¹,

Stach²,

Otáhal³

2012

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Ecarin is one of the most clinically important components and it is direct activator of prothrombin to izoenzym meizothrombin, which is not inactivated by antithrombin-heparin complex and causes explosive thrombin activation (Gillissen et al, 1994;Lu et al, 2005). In contrary to disseminated intravascular coagulation (DIC), antithrombin, at least in the initial phase, remains intact or can be even elevated (Mba and Onyemelukwe, 1989). The uncontrolled thrombin generation produces fibrin formations, which are destructed by plasmin into large quantity of fibrin degradation products (FDP, D-dimer).…”

Section: Introductionmentioning

confidence: 99%

Snakebite Envenoming by Sochurek’s Saw-scaled Viper Echis Carinatus Sochureki

2016

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A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed. Despite administration of 10 vials of urgently imported Polyvalent Snake Antivenom Saudi Arabia, the venom-induced consumption coagulopathy (VICC) and AKI persisted. Another ten vials of antivenom were imported from abroad. VICC slowly subsided during the antivenom treatment and disappeared after administration of total 20 vials during 5 day period. No signs of haemorrhage were present during treatment. After resolving VICC, patient was transferred to Department of Nephrology for persisting AKI and requirement for haemodialysis. AKI completely resolved after 20 days. Despite rather timed administration of appropriate antivenom, VICC and AKI developed and the quantity of 20 vials was needed to cease acute symptoms of systemic envenoming. The course illustrates low immunogenicity of the venom haemocoagulation components and thus higher requirements of the antivenom in similar cases.

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Studies on Blood Coagulation and Fibrinolysis in Patients Bitten by Bothrops jararaca (jararaca)

et al. 1990

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SummaryThe blood coagulation and the fibrinolytic systems of nine patients envenomed by Bothrops jararaca in São Paulo (Brazil) were studied. Five of the accidents were caused by young snakes (<50 cm). On admission, four patients had non-clotting and three partially-clotting blood. Fibrinogen levels were decreased due to the thrombin-like activity of the venom as expected. Consequent secondary activation of the fibrinolytic system was evident from the low levels of alpha-2-antiplasmin and the high titres of fibrin(ogen) degradation products. High titres of cross-linked fibrin fragment D (D-dimer) in seven patients together with decreased platelet counts and/or factor V, and/or factor VIII in some, suggests intrinsic thrombin formation as these factors are not consumed in the defibrinogenation induced by venom thrombin-like fractions such as Ancrod and Batroxobin. However, normal or increased levels of antithrombin III in all and normal levels of factor II in eight patients do not support this interpretation. The existence of variable concentrations of other proteins in the venom of B. jararaca such as botrocetin and thrombocytin isolated from B. jararaca and B. atrox or crotalocytin from Crotaliis horridus venom should be considered. Such proteins are known to activate factors V, VIII, XIII, and platelets without affecting prothrombin (factor II) and antithrombin III. Slower recovery of the haemostatic disturbances after antivenom administration to patients bitten by young snakes suggests a more severe coagulopathy in such accidents. This is supported by clinical observations.

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Antithrombin III in <i>Echis</i><i>carinatus</i> Envenomation in Northern Nigeria

Cited by 3 publications

References 10 publications

Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Protobothrops mangshanensis bite: first clinical report of envenoming and its treatment

Snakebite Envenoming by Sochurek’s Saw-scaled Viper Echis Carinatus Sochureki

Studies on Blood Coagulation and Fibrinolysis in Patients Bitten by Bothrops jararaca (jararaca)

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