Thrombotic microangiopathy due to Viperidae bite: Two case reports

Dineshkumar, Thanigachalam; Dhanapriya, J; Sakthirajan, Ramanathan; Thirumalvalavan, K; Kurien, AA; Balasubramaniyan, T; Gopalakrishnan, Natarajan

doi:10.4103/0971-4065.196936

Cited by 21 publications

(23 citation statements)

References 15 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been reported in conjunction with venom-induced consumption coagulopathy (VICC), with the triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and renal failure persisting long after VICC resolves, or in isolation raising the possibility of an acquired hemolytic uremic syndrome (HUS)–like syndrome. [45678910111213] In this study, we describe a series of snake-bite-induced TMA and compare its outcomes with that of other causes of AKI following snake bite.…”

Section: Introductionmentioning

confidence: 99%

Thrombotic microangiopathy: An under-recognised cause of snake-bite-related acute kidney injury

Rao¹,

Attur²,

Nagaraju³

et al. 2019

Indian J Nephrol

View full text Add to dashboard Cite

Introduction:Thrombotic microangiopathy (TMA) as a cause of snake-bite-induced acute kidney injury (AKI) is rarely reported. Very little is known about the clinical course, optimal management, and prognosis of this entity. We describe a series of snake-bite-induced TMA and compare their outcomes with those without TMA.Methods:This was a single-center retrospective study of patients with AKI following snake envenomation admitted between January 2012 and December 2017. Demographic profile, clinical parameters, and outcomes were studied. TMA was diagnosed based on presence of triad of microangiopathic hemolytic anemia, thrombocytopenia, and AKI, and groups with and without TMA were compared.Results:Of 103 patients with AKI following snake bite, 19 (18.5%) had clinical evidence of TMA. All patients with TMA had advanced azotemia (mean peak serum creatinine 9.5 ± 3.0 mg/dL), with 18 (95%) requiring renal replacement therapy (RRT). Thirteen (68%) had either complete or partial recovery of renal functions, two (10%) progressed to end-stage renal disease, and one died (three patients were lost to follow-up). Age ≥50 years, presence of oliguria/anuria, anti-snake venom dose ≥10 vials, and urea ≥80 mg/dL at presentation were independently associated with TMA (P < 0.05). RRT requirement (95% vs. 57%), mean number of RRT sessions (18 vs. 4.5 sessions), and hospital stay ≥7 days (84% vs. 58%) were higher in patients with TMA (P < 0.05), but patient outcomes did not differ.Conclusions:In conclusion, TMA was seen in 18.5% of patients with snake-bite-related AKI in our study and was associated with almost universal need for RRT, longer duration on RRT, and hospital stay compared with patients without TMA.

show abstract

Section: Introductionmentioning

confidence: 99%

Thrombotic microangiopathy: An under-recognised cause of snake-bite-related acute kidney injury

Rao¹,

Attur²,

Nagaraju³

et al. 2019

Indian J Nephrol

View full text Add to dashboard Cite

show abstract

“…There are two reports of snake bite induced TMA from India in early 1986[43] and recently in 2017. [44] In the later report from India, TPE was tried for one patient with TMA who showed improvement with the treatment. [44] In our two patients (Case no.…”

Section: Discussionmentioning

confidence: 99%

“…[44] In the later report from India, TPE was tried for one patient with TMA who showed improvement with the treatment. [44] In our two patients (Case no. 9 and 10), there was no evidence of DIC.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience

Saravanan

Ranjit

Jayakumar

et al. 2018

Asian J Transfus Sci

View full text Add to dashboard Cite

INTRODUCTION:Outcome data in pediatric plasma exchange, especially in nonrenal indications are scarce. We aimed to evaluate its role and outcome in our patients.SUBJECTS AND METHODS:A retrospective study of children admitted in the year 2016 to the Pediatric Intensive Care Unit requiring plasma exchange for nonrenal indications was undertaken. Plasma exchange was given as adjunctive therapy along with primary treatment for the disease concerned. Demographic and clinical data were studied, and descriptive statistical analysis was carried out.RESULTS:Ten children underwent plasma exchange during this 1-year period with a male: female ratio of 3:2 and a mean age of 10 years (range 3–16 years). The indications were acute disseminated encephalomyelitis (n = 2), acute neuromyelitis optica (n = 1), catastrophic antiphospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n = 1), severe SLE with cerebritis/hemophagocytic lymphohistiocytosis (HLH) (n = 2), severe dengue sepsis with HLH/multi-organ dysfunction syndrome (n = 2), and thrombotic microangiopathy secondary to snake bite envenomation (n = 2). All received either 1.5 or 2 times plasma volume exchange (mean sessions – 4, range = 1–6). The mean duration of stay in hospital was 17.2 days (range = 3–40 days), and follow-up was 78 days (range = 3–180 days), with the majority of children (8/10, 80%) survived from the catastrophic illness at the time of discharge. Two children (2/10, 20%) succumbed due to the disease per se in severe dengue sepsis in one and enterobacteriaceae sepsis (hospital-acquired pneumonia) in another.CONCLUSION:Plasma exchange was found to be beneficial as complementary therapy in a critical care setting, especially for nonrenal indications.

show abstract

“…Whilst VICC meets the definitions of commonly used diagnostic scoring systems for DIC, the differing pathophysiology, outcomes, and prognosis of VICC compared to DIC clearly differentiate it [3, 6, 7]. A small subset of snakebite patients with VICC develop a thrombotic microangiopathy (TMA) [3, 8–17]. The reported cases of snakebite-associated TMA present with a delayed phase thrombocytopenia and a haemolysis in keeping with microangiopathic haemolytic anaemia (MAHA) [11].…”

Section: Introductionmentioning

confidence: 99%

Snakebite associated thrombotic microangiopathy: a protocol for the systematic review of clinical features, outcomes, and role of interventions

Noutsos

Currie

2019

Syst Rev

View full text Add to dashboard Cite

Background Thrombotic microangiopathy is an uncommon complication of snake envenoming associated with a subset of snakebite cases presenting with venom-induced consumption coagulopathy. It presents with microangiopathic haemolytic anaemia and thrombocytopenia. Available studies are predominantly small retrospective observational studies only. Renal end organ injury appears common. It has variably been likened to either thrombotic thrombocytopenic purpura or atypical haemolytic uraemic syndrome. Many studies report acute kidney injury, with dialysis required in a subset of patients. Some studies suggest a role for treatment with plasmapheresis. Interpretation of the literature is complicated by variable nomenclature and historically poor case definitions of both venom-induced consumption coagulopathy and thrombotic microangiopathy associated with snake envenoming. Methods The main objective of this systematic review is to synthesise the worldwide experience of snakebite-associated thrombotic microangiopathy with respect to its features and outcomes, and collate any evidence for the role of plasmapheresis as treatment. A predetermined case definition of confirmed or suspected snakebite with either blood film evidence of microangiopathic haemolytic anaemia or histological evidence of thrombotic microangiopathy will be used. This case definition will determine the search terms and study inclusion criteria. Relevant studies will be identified by electronic database, published conference abstracts, and grey literature search. This systematic review will be performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The quality of included studies will be assessed by a proposed tool for evaluating the methodological quality of case reports and case series. Results will be reported by a descriptive synthesis with a focus on the presenting features; outcomes of acute kidney injury, dialysis-free survival, other end organ damage, and overall survival; and any evidence of a role for treatment with plasmapheresis. The quality of accumulated evidence will be assessed via the Grading of Recommendations, Assessment, Development, and Evaluations framework. Discussion It is anticipated that eligible studies will consist of small observational studies. Evidence gathered from this review will provide the first broader understanding of the clinical features, outcomes, prognosis, and management of snakebite-associated thrombotic microangiopathy. Systematic review registration PROSPERO CRD42019121436 Electronic supplementary material The online version of this article (10.1186/s13643-019-1133-2) contains supplementary material, which is available to authorized users.

show abstract

Thrombotic microangiopathy due to Viperidae bite: Two case reports

Cited by 21 publications

References 15 publications

Thrombotic microangiopathy: An under-recognised cause of snake-bite-related acute kidney injury

Thrombotic microangiopathy: An under-recognised cause of snake-bite-related acute kidney injury

Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience

Snakebite associated thrombotic microangiopathy: a protocol for the systematic review of clinical features, outcomes, and role of interventions

Contact Info

Product

Resources

About