Thrombotic microangiopathy following hump-nosed viper ‘<i>Hypnale’</i> envenomation

Puthra, S.; Pirasath, Selladurai; Sugathapala, Athwel Gamarallage Hemal; Gnanathasan, Ariaranee

doi:10.1177/2050313x20944308

Cited by 5 publications

(8 citation statements)

References 11 publications

(19 reference statements)

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“…Its sensitivity can be improved to 80% when the test is performed under standardized conditions [ 23 ]. The need for an alternative bedside test which addresses its shortcomings has been highlighted [ 24 ]. We have previously demonstrated that EXTEM-CT in ROTEM has a 93% sensitivity and 92% accuracy in detecting Russell’s viper envenoming over WBCT20 [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The antivenom available in Sri Lanka is sourced from India and is effective in envenomation by Indian species of Naja naja , Bungarus caeruleus , Daboia russelii and Echis carinatus . The lack of efficacy of this polyvalent antivenom in HNV has been shown in many studies [ 6 , 17 , 24 ]. Despite this, many physicians use this antivenom in HNV bites [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

Alvitigala

Gooneratne

Dharmasena³

et al. 2023

Trop Dis Travel Med Vaccines

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Background Hump-nosed vipers (HNV; Hypnale spp) are one of the medically important venomous snakes in Sri Lanka and South-Western regions of India. The haemostatic dysfunction due to HNV bites is poorly characterized by standard diagnostic tests performed to identify coagulopathy. We aimed to determine the usefulness of rotational thromboelastometry (ROTEM) parameters compared to 20-minute whole blood clotting test (WBCT20) and prothrombin time (PT) in understanding the coagulopathy of HNV bites. Methods Twenty-three HNV snakebite patients in a prospective study of 127 consecutive snakebites were recruited. After recording details of the clinical presentation, PT/international normalized ratio (INR), WBCT20 and ROTEM delta were performed at presentation. Results In this preliminary study, none of the patients had clinically apparent bleeding. Coagulopathy was detected by either WBCT20, INR or ROTEM in 13 HNV patients. Eleven had a coagulopathy detectable by ROTEM (either abnormal EXTEM-CT, INTEM-CT or FIBTEM-MCF) but with negative WBCT20. Of them, only two had prolonged INR values. Two patients had positive WBCT20 but with normal ROTEM and INR values. The remaining 10 patients did not show any coagulopathy either by INR, ROTEM or WBCT20. Conclusion In this preliminary study with small number of sample size, ROTEM parameters appeared to be more sensitive to subtle changes in coagulation compared to WBCT20. The clinical utility of detecting these changes and their usefulness in managing snakebite should be explored further in a larger study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

Alvitigala

Gooneratne

Dharmasena³

et al. 2023

Trop Dis Travel Med Vaccines

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“… 20 TMA associated with snake bites such as hump-nosed pit viper (Genus: Hypnale ), Russell’s viper ( Daboia russelii ), lowland viper ( Proatheris superciliaris ), Australian brown snake ( Pseudonaja ) and coastal taipan snake ( Oxyuranus ) and Saharan horned viper ( Cerastes cerastes ) has been described in the literature. 17 , 22 – 26 …”

Section: Discussionmentioning

confidence: 99%

“…20 TMA associated with snake bites such as hump-nosed pit viper (Genus: Hypnale), Russell's viper (Daboia russelii), lowland viper (Proatheris superciliaris), Australian brown snake (Pseudonaja) and coastal taipan snake (Oxyuranus) and Saharan horned viper (Cerastes cerastes) has been described in the literature. 17,[22][23][24][25][26] Plasma exchange has a role in the treatment of TMA following snake bite. It decreases the further endothelial damage of blood vessels and normalizes the coagulation cascade and platelet aggregation via removal of toxins from blood.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic microangiopathy following saw-scaled viper (Echis carinatus) envenoming in Sri Lanka

Pirasath

Athirayan

Gajan

2021

SAGE Open Medical Case Reports

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The saw-scaled viper ( Echis carinatus) is considered as a highly venomous snake in Sri Lanka. The clinical manifestations are localized pain and swelling, coagulopathy and renal impairment. Thrombotic microangiopathy is rarely reported as a complication of saw-scaled viper envenoming. The clinical manifestations of thrombotic microangiopathy include thrombocytopenia, microangiopathic haemolytic anaemia and acute kidney injury. The consumption coagulopathy of post-envenoming could be followed by a syndrome consistent with thrombotic microangiopathy. We describe a patient with thrombotic microangiopathy following saw-scaled viper systemic envenoming which was managed with antivenom and supportive therapy. The dead snake which was brought by patient was identified by medical professional as saw-scaled viper ( E. carinatus) based on morphological features. This case illustrates a rare manifestation thrombotic microangiopathy following saw-scaled viper envenoming.

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“…[5][6][7] Acute tubular necrosis is the most common cause of AKI (80%), followed by interstitial nephritis (15%) and, more rarely, thrombotic microangiopathy (TMA) (approximately 5% of cases). 8,9 The species involved in the development of TMA are Hypnale hypnale, [10][11][12][13] Pseudonaja spp, 14 Notechis scutatus, 15 Daboia russellii, 16,17 Bothrops jararaca, 18,19 Echis coloratus, 20,21 Bothrops erythromelas, 22 and Bothrops lanceolatus. 23 Some cases of TMA may progress to renal cortical necrosis.…”

Section: Introductionmentioning

confidence: 99%

Atypical Hemolytic Uremic Syndrome in a Patient With Bothrops asper Envenomation

Cañas

Vecino

Posso-Osorio

2022

Wilderness & Environmental Medicine

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Bothrops asper envenomation is common in Colombia and is characterized by local tissue injury and venom-induced consumption coagulopathy (VICC). Rarely, thrombotic microangiopathy is associated with envenomation by this species. The case of a 57-y-old man with B asper bite and envenomation on the left foot is presented. The patient was admitted 8 h after the event and progressively developed edema, hemorrhage at the site of the bite, and hemorrhagic blisters. His coagulation test results (prothrombin and partial thromboplastin times) were prolonged, and his fibrinogen levels were severely reduced. The diagnosis of VICC was made. Administration of Colombian polyvalent viper antivenom controlled the VICC within a few hours. Subsequently, the patient developed severe microangiopathic anemia, thrombocytopenia, and acute kidney injury. A diagnosis of thrombotic microangiopathy was made, and the patient met the criteria for hemolytic uremic syndrome. Management with hemodialysis in addition to therapeutic plasma exchange and replacement with fresh frozen plasma was indicated. The patient's condition resolved 14 d later. To the best of our knowledge, this is the first case of B asper envenomation in which the patient presented with hemolytic uremic syndrome after VICC. A proposal is made regarding the pathogenesis of this chain of events.

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Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

Cited by 5 publications

References 11 publications

The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

Thrombotic microangiopathy following saw-scaled viper (Echis carinatus) envenoming in Sri Lanka

Atypical Hemolytic Uremic Syndrome in a Patient With Bothrops asper Envenomation

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