Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia Following Hump-Nosed Pit Viper (<i>Hypnale hypnale</i>) Bite in Sri Lanka

Rathnayaka, R.M.M.K. Namal; Kularatne, S.A.M.; Ranathunga, Anusha Nishanthi; Kumarasinghe, Mahinda; Rajapakse, Jayantha; Ranasinghe, Shalindra

doi:10.1016/j.wem.2017.05.005

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…Namal Rathnayaka et al 22 described Hypnale coagulopathy presenting as prolonged coagulopathy along with ecchymosis and microangiopathic haemolytic anaemia following H. hypnale bite. It is interesting to note that this is not a common feature seen in other viper envenomation.…”

Section: Microangiopathic Haemolytic Anaemiamentioning

confidence: 99%

Hypnale Coagulopathy: Snake Envenomation of a Different Kind

Naik¹

2021

Journal of the Royal College of Physicians of Edinburgh

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Hypnale hypnale is a small pit viper that is known as the hump-nosed pit viper (HNV) or ‘Merrem’s hump-nosed pit viper’ and is endemic to Sri Lanka and the Western Ghats of South India. Previously, it was thought that this viper bite would result in mild systemic or local envenomation, however, we now know that HNV bites could cause severe systemic toxicity and mortality. The most common systemic toxicity of this viper envenomation is coagulopathy, which is known as ‘Hypnale coagulopathy’. Hypnale coagulopathy is quite different from the haemotoxicity caused by other vipers. In this paper, an effort has been made to discuss the unique and unpredictable nature of this coagulopathy due to Hypnale envenomation.

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Section: Microangiopathic Haemolytic Anaemiamentioning

confidence: 99%

Hypnale Coagulopathy: Snake Envenomation of a Different Kind

Naik¹

2021

Journal of the Royal College of Physicians of Edinburgh

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“…Although local envenoming occurs more frequently after Hypnale bites, 8 -11 systemic effects such as AKI, CKD, 12,13 VICC, 2,14 -16 thrombotic microangiopathy (TMA), 13,17,18 ischemic strokes, 19 myocardial infarction, atrial fibrillation, and cardiac arrest 4,20 have also been reported. Of the 3 species, H hypnale 10,11,16,21 and H zara 2,11,18 cause VICC, but such complications have not so far been reported after H nepa bites.…”

Section: Introductionmentioning

confidence: 99%

Venom-Induced Consumption Coagulopathy Following Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka: Uncertain Efficacy of Fresh Frozen Plasma

Rathnayaka

Ranathunga

Kularatne

2020

Wilderness & Environmental Medicine

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IntroductiondHump-nosed pit vipers (Hypnale spp) cause the highest number of venomous snakebites in Sri Lanka. Bites commonly cause local envenoming leading to local pain, swelling, and necrosis of the site of the bite. Acute kidney injury is the most common systemic manifestation, and some patients develop venom-induced consumption coagulopathy (VICC). Genus Hypnale comprises 3 species. Of them, H hypnale is found in Sri Lanka and the Western Ghats region of India. The other 2 (H nepa and H zara) are endemic species in Sri Lanka.MethodsdThis study included 500 patients with hump-nosed viper bites studied prospectively over 4.5 y starting June 2014. All patients were assessed and the data were collected by the principal investigator (primary data). A subgroup of patients who developed VICC is described. There were 2 groups, including proven (patients with the specimen of the snake) and probable (specimen of snake not available) bites.ResultsdThirty (n=500; 6%) patients developed VICC; of them, 17 (3%) were proven cases, and 13 (2%) were probable cases. In both groups, 24 (80%) recovered, 2 (7%) progressed to chronic kidney disease, 1 (3%) died of severe hemostatic dysfunction, and 3 (10%) were lost to follow-up. Systemic bleeding was observed in 16 patients (53%), including hematuria (microscopic and gross) in 8 (27%) and venipuncture bleeding in 5 (17%). Eleven (37%) developed local bleeding at the site of the bite. Fresh frozen plasma was administered to 20 patients (67%), among whom only 11 (55%) experienced early correction of VICC. In both groups, 15 (50%) developed acute kidney injury, and 2 (7%) progressed to chronic kidney disease. Microangiopathic hemolysis was observed in 18 patients (60%) and thrombocytopenia in 16 (53%). Thrombotic microangiopathy was detected in 13 patients (43%), of whom 10 (33%) developed hemolytic uremic syndrome and 2 (7%) had thrombotic thrombocytopenic purpura. Of patients with VICC in the proven group, 94% (n=16) was caused by H hypnale and 1 (6%) was caused by H zara. In the proven group, median international normalized ratio was 3.7 (interquartile range 1.6e5.0); in the probable group, it was 5.0 (interquartile range 2.1e5.4).ConclusionsdWe found that 6% of patients develop hemostatic dysfunction after hump-nosed viper bites. However, which patients will develop coagulopathy or die of envenoming is unpredictable. Reliable and accessible treatments are unmet essential needs because antivenoms for these bites are currently not available in the country. Therapy with fresh frozen plasma has doubtful efficacy in early correction of VICC and needs further evaluation.

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“…16 Most commonly, hump-nosed pit vipers cause local envenoming effects such as pain, swelling, hemorrhagic blistering, and necrosis 10,17,18 and rarely systemic manifestations like coagulopathy, acute kidney injury, and chronic kidney disease. 10,19,20,21 MAHA associated with thrombotic microangiopathy is a well-known complication after viperidae snakebites, including hump-nosed pit vipers 8,22,23 and Russell's vipers (Daboia russelii). 24 The pathophysiology of MAHA is due to damage of the endothelial layer of small blood vessels with resulting fibrin deposition and platelet aggregation.…”

Section: Discussionmentioning

confidence: 99%

Microangiopathic Hemolytic Anemia Following Three Different Species of Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

Rathnayaka

Ranathunga²,

Kularatne

et al. 2018

Wilderness & Environmental Medicine

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There are 3 species of hump-nosed pit vipers in Sri Lanka: Hypnale hypnale, Hypnale zara, and Hypnale nepa. The latter 2 are endemic to the country. Microangiopathic hemolytic anemia (MAHA) is a known complication of hump-nosed pit viper bites. It was previously documented as a complication of general viper bites and not species specific. We report a series of 3 patients who developed MAHA after being bitten by each species of hump-nosed pit viper. The first patient was bitten by H hypnale and developed a severe form of MAHA associated with acute kidney injury and thrombocytopenia falling into the category of thrombotic microangiopathy. The other 2 developed MAHA that resolved without any complications.

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Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite in Sri Lanka

Cited by 7 publications

References 29 publications

Hypnale Coagulopathy: Snake Envenomation of a Different Kind

Hypnale Coagulopathy: Snake Envenomation of a Different Kind

Venom-Induced Consumption Coagulopathy Following Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka: Uncertain Efficacy of Fresh Frozen Plasma

Microangiopathic Hemolytic Anemia Following Three Different Species of Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

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