Plasma exchange as a complementary approach to snake bite treatment: An academic emergency department’s experiences

Zengin, Suat; Yilmaz, Mehmet Birhan; Al, Behçet; Yıldırım, Cuma; Yarbil, Pınar; Kılıç, Hasan; Bozkurt, Selim; Köse, Ataman; Bayraktaroǧlu, Ziya

doi:10.1016/j.transci.2013.03.006

Cited by 21 publications

(14 citation statements)

References 17 publications

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“…Daily TPE helped to improve the TMA features in this case; however, the exact pathogenesis of TMA in such cases remains unclear. According to reports from Turkey, there was significant improvement in hematological parameters after TPE and the authors suggested TPE as a complementary therapeutic option in snake bite patients . But all these findings were attributed to the removal of venom from the circulation and had no mention about the role of TPE in TMA following snake bite.…”

Section: Discussionmentioning

confidence: 99%

“…In a case report from Australia, MAHA and thrombocytopenia improved after 3 cycles of TPE with FFP, but renal functions remained unchanged . According to Zengin et al, there was no difference between FFP and Albumin solution in the outcome of patients who received TPE following snake bite . One case report from India comments about the better prognosis of two patients following TPE with a combination of FFP and HAS who were timely diagnosed with HUS following snake bite .…”

Section: Discussionmentioning

confidence: 99%

“…6 According to Zengin et al, there was no difference between FFP and Albumin solution in the outcome of patients who received TPE following snake bite. 5 One case report from India comments about the better prognosis of two patients following TPE with a combination of FFP and HAS who were timely diagnosed with HUS following snake bite. 7 However, we do believe that FFP will have an advantage over HAS especially during the initial period where patients might have a co-existing VICC and they are expected to receive blood transfusion because of the same, and hence further work in this area should be encouraged.…”

Section: Discussionmentioning

confidence: 99%

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Role of therapeutic plasma exchange in snake bite associated thrombotic microangiopathy—A case report with review of literature

Mohan

Guduri

Shastry

2019

J of Clinical Apheresis

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Post snake bite renal failure due to thrombotic microangiopathy (TMA) is often overlooked and not considered as a separate entity while managing the patient. This case report highlights the efficacy of Therapeutic Plasma Exchange in managing the post envenomation TMA. Anti‐snake venom was administered following severe hematotoxic envenomation, but later on developed acute kidney injury and hence hemodialysis was done for 2 days without much improvement. On third day of bite, diagnosis of TMA was made from microangiopathic hemolytic picture in peripheral blood smear, thrombocytopenia and renal failure. Therapeutic plasma exchange with human albumin solution was started on a daily basis and after 3 cycles, patient's condition improved as shown by the laboratory parameters. Though this entity is not well defined, the supporting evidence is found in few reports of published literature. Hence, we propose plasma exchange as an adjunctive therapeutic option in post snake TMA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Role of therapeutic plasma exchange in snake bite associated thrombotic microangiopathy—A case report with review of literature

Mohan

Guduri

Shastry

2019

J of Clinical Apheresis

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“…ALP activity has been examined among a wide variety of snake toxins and found to be distributed ubiquitously [6,23]. Hydrolytic enzymes including proteases, phosphatases, nucleases and nucleotidases, are all ubiquitously found in almost all snake venoms, and they are responsible for local tissue damage, leading to necrosis, hemorrhage, and edema [6,24,25]. ALP level was high in 79.3% of our patients, and according to our results, diffuse edema was found in all patients in whom snake antiserum was initiated, and diffuse edema was statistically ahead of the other findings for initiation of snake antiserum (P= 0.003).…”

Section: Treatmentmentioning

confidence: 99%

Management of Poisonous Snake Bites: Analysis of 29 Cases

et al. 2018

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Objectives:The objective of this retrospective study is to provide contribution for management of the poisonous snake bites by comparison results of this study with the literature data. Patients and Methods:This study retrospectively analyzed the demographic and epidemiologic characteristics of 40 patients who presented due to snake bites. 29 patients were included in this study. Patients' age, sex, month of admission, duration of follow-up in the emergency room, laboratory outcomes, the regions of snake bite, number of the bites, local and systemic symptoms, and treatment received were assessed. Patients aged under 18 years were excluded from the study. Also patients were excluded if the snakes were not seen after the patients were bitten or if they developed no local or systemic symptoms within four hours after the bite. In addition, patients in whom adequate data could not be obtained were also excluded from the study. Results:Out of the 29 patients included in this study, 15 (51.7%) were females. When the patients were examined according to local and systemic findings; local symptoms were observed in 18 patients (62.1%) and systemic symptoms in 11 patients (37.9%). There was a positive correlation between elevated ALP and diffuse edema in the bite area and hypotension findings. When durations of hospitalization were analyzed, the mean duration of hospitalization was 2.3±1.5 days. Conclusion:We believe that, symptomatic and supportive treatment could be sufficient in majority of the patients with snake bites in our region, and a low dose antiserum therapy would be reasonable when antiserum is needed.

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“…Treatment of last resort may be the use of plasma exchange therapy (Zengin et al, 2013). The outcome, however, is not always fully satisfying (Valenta et al, 2011).…”

Section: Treatmentmentioning

confidence: 99%

Severe Snakebite Envenoming in Intensive Care

2016

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Snakebites by exotic venomous snakes can cause serious or even life-threatening envenoming. In Europe and North America most victims are breeders, with a few snakebites from wild native American rattlesnakes. The envenomed victims may present in organ and/or system failure with muscle paralysis, respiratory failure, circulatory instability, acute kidney injury, severe coagulation disorder, and local disability - compartment syndrome and necrosis. Best managed by close collaboration between clinical toxicology and intensive care, most severe envenomings are managed primarily by intensive care physicians. Due to the low incidence of severe envenoming, the clinical course and correct management of these cases are not intrinsically familiar to most physicians. This review article summarizes the clinical syndromes caused by severe envenoming and the therapeutic options available in the intensive care setting.

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Plasma exchange as a complementary approach to snake bite treatment: An academic emergency department’s experiences

Cited by 21 publications

References 17 publications

Role of therapeutic plasma exchange in snake bite associated thrombotic microangiopathy—A case report with review of literature

Role of therapeutic plasma exchange in snake bite associated thrombotic microangiopathy—A case report with review of literature

Management of Poisonous Snake Bites: Analysis of 29 Cases

Severe Snakebite Envenoming in Intensive Care

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