Investigation of coagulopathy in three cases of tiger snake (Notechis ater occidentalis) envenomation

Ferguson, Lucy A.; Morling, Alan; Moraes, Caroline Krieger de; Baker, Ross

doi:10.1080/003130201201117172

Cited by 17 publications

(11 citation statements)

References 16 publications

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“…Neutralization of these peptides and enzymes with antivenom is generally warranted, because selective elimination of these molecules has proved impossible. In this regard, previous case reports support the efficacy of plasmapheresis in the treatment of envenomations including patients with coagulopathies [17,19,20]. Beneficial effects of plasmapheresis in the patients presented here may also be due to the elimination of these inflammatory peptides.…”

Section: Discussionsupporting

confidence: 73%

“…[18]. Other case reports support the efficacy of plasmapheresis in the treatment of envenomations including patients with coagulopathies [19,20]. Despite a lack of an adequate control group, we believe that reduced hospital stays, minimal adverse complications, and the potential for salvage of limbs in victims of snake bites support the early use of plasmapheresis in such settings.…”

Section: Discussionmentioning

confidence: 77%

“…Antivenom produced from sheep is less allergic than that from other sources but its availability may be a problem (not available in Turkey) [24]. Enzymes and low molecular weight peptides in the snake venom can also cause problems leading to coagulopathy [8,[19][20][21]. Neutralization of these peptides and enzymes with antivenom is generally warranted, because selective elimination of these molecules has proved impossible.…”

Section: Discussionmentioning

confidence: 99%

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The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: An academic emergency department's experiences

et al. 2006

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The objective of this study is to describe the clinical status, procedural interventions, and outcomes of critically ill patients with poisoning and snake bite injuries presenting to a tertiary-care emergency department for treatment with therapeutic plasmapheresis. Records of 20 patients who presented to our academic emergency department over a 2-year period and who underwent plasmapheresis for poisoning or snake bite were retrospectively reviewed. Plasmapheresis was performed using centrifugation technology via an intravenous antecubital venous or subclavian vein catheter access. Human albumin or fresh frozen plasma were used as replacement fluids. Data extracted from the patient record included demographic data, clinical status, and outcome measures. Sixteen patients underwent plasmapheresis because of toxicity from snake bite. Three patients were treated for drug poisoning (phenytoin, theophylline, bipyridene HCl) and one patient for mushroom poisoning. Haematologic parameters such as platelet count, PT, and INR resolved rapidly in victims of snake bite injuries after treatment with plasmapheresis. Loss of limbs did not occur in these cases. Seven patients required admission to the intensive care unit. One patient with mushroom poisoning died. Mean length of hospital stay was 14.3 days (range 3-28 days) for all cases. Plasmapheresis was a clinically effective and safe approach in the treatment of snake bite envenomation and other drug poisoning victims especially in the management of hematologic problems and in limb preservation/salvage strategies. In addition to established conventional therapies, emergency physicians should consider plasmapheresis among the therapeutic options in treatment strategies for selected toxicologic emergencies.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: An academic emergency department's experiences

et al. 2006

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“…Another study reported there is transient presence of an inhibitor to factors VIII, IX and XI in cases of tiger snake envenomation [15]. In our case, cobra toxin was probably the cause of development of factor VIII inhibitor, since the acquired factor VIII deficiency developed right after consuming the cobra toxin, and we did not find any other possible cause of acquired factor VIII deficiency in this patient.…”

Section: Discussionsupporting

confidence: 51%

Acquired factor VIII deficiency after consuming the dried gallbladder of a cobra,Naja naja

Kim

Lee

et al. 2010

Korean J Hematol

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Acquired factor VIII deficiency is very rare, often fatal. It is associated with pregnancy, autoimmune diseases, malignancy, and drugs, although no underlying cause is found in 50%. A 49-year-old male was referred with right shoulder bruising. The coagulation test showed a prolonged activated partial thromboplastin time. The factor VIII level was less than 1%, and the factor VIII inhibitor antibody titer was 246 Bethesda units/mL. The findings were compatible with acquired factor VIII deficiency. He had consumed the dried gallbladder of a cobra, Naja naja, for two weeks, it contained venom. After the initial treatment with factor VIII, he did not take supplemental coagulation factor VIII. The patient was readmitted with left forearm swelling. He lost consciousness suddenly and brain computed tomography (CT) revealed a subdural hematoma. Despite administering recombinant factor VII, his bleeding was not controlled and he died.

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“…Such studies include the M A N U S C R I P T 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 measurement of various clinical indications, such as serum creatine kinase (CK), creatinine levels for myotoxic effects (Ponraj andGopalakrishnakone 1997, 1996) (Ferguson et al 2002;Isbister et al 2002Isbister et al , 2006. Testing of venoms in vitro on various animal derived primary and cultured cells (Hodgson and Wickramaratna 2002;Kubo et al 2002;Kuruppu et al 2006;Marshall and Herrmann 1989;Rigoni et al 2004) and on animal nerve-muscle preparations (Ramasamy et al 2004;Zamuner et al 2004) have aided our understanding of mechanisms of action and toxicities, while others observed histopathological changes in animal tissues after injection of venom or purified venom toxins (Mandal and Bhattacharyya 2007;Ponraj, 1997) to define sites and mechanisms of action.…”

Section: Introductionmentioning

confidence: 99%

Histopathological analysis and in situ localisation of Australian tiger snake venom in two clinically envenomed domestic animals

Jacoby-Alner

Stephens

Davern³

et al. 2011

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Investigation of coagulopathy in three cases of tiger snake (Notechis ater occidentalis) envenomation

Cited by 17 publications

References 16 publications

The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: An academic emergency department's experiences

The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: An academic emergency department's experiences

Acquired factor VIII deficiency after consuming the dried gallbladder of a cobra,Naja naja

Histopathological analysis and in situ localisation of Australian tiger snake venom in two clinically envenomed domestic animals

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