Thrombotic Microangiopathy Following Arabian Saw-Scaled Viper (Echis coloratus) Bite: Case Report

Obeidat, Mohammad; Al-Swailmeen, Ali Mohammad; Al-Sarayreh, Mohammad; Rahahleh, Khaldoun Mohammad

doi:10.12659/ajcr.922000

Cited by 6 publications

(3 citation statements)

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“…Snakebite-associated TMA resembles HUS with its predilection for renal end-organ damage, but any association beyond this common presenting feature has not been established. Some studies have reported the AKI of snakebite associated TMA as self-limiting [17,20], whilst other small studies have claimed effectiveness of intervention with therapeutic plasma exchange (TPE) [12,[21][22][23]. TPE has a strong evidence base for preventing the high mortality in TTP [9].…”

Section: And Bleedingmentioning

confidence: 99%

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Noutsos

Currie

Wijewickrama

2022

Toxins

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Snakebite is a significant and under-resourced global public health issue. Snake venoms cause a variety of potentially fatal clinical toxin syndromes, including venom-induced consumption coagulopathy (VICC) which is associated with major haemorrhage. A subset of patients with VICC develop a thrombotic microangiopathy (TMA). This article reviews recent evidence regarding snakebite-associated TMA and its epidemiology, diagnosis, outcomes, and effectiveness of interventions including antivenom and therapeutic plasma-exchange. Snakebite-associated TMA presents with microangiopathic haemolytic anaemia (evidenced by schistocytes on the blood film), thrombocytopenia in almost all cases, and a spectrum of acute kidney injury (AKI). A proportion of patients require dialysis, most survive and achieve dialysis free survival. There is no evidence that antivenom prevents TMA specifically, but early antivenom remains the mainstay of treatment for snake envenoming. There is no evidence for therapeutic plasma-exchange being effective. We propose diagnostic criteria for snakebite-associated TMA as anaemia with >1.0% schistocytes on blood film examination, together with absolute thrombocytopenia (<150 × 109/L) or a relative decrease in platelet count of >25% from baseline. Patients are at risk of long-term chronic kidney disease and long term follow up is recommended.

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Section: And Bleedingmentioning

confidence: 99%

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Noutsos

Currie

Wijewickrama

2022

Toxins

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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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“…[1][2][3][4][5] Thrombotic microangiopathy (TMA) is extremely rarely reported following SSV envenoming in the literature. 6 The presence of thrombocytopenia, microangiopathic haemolytic anaemia and acute kidney injury (AKI) favours the diagnosis of TMA 7,8 which may co-exist with venom-induced consumption coagulopathy (VICC) or after resolution of VICC. 9 The overlap between TMA and VICC is common reason for mistaken idea that snake bites cause disseminated intravascular coagulation.…”

Section: Introductionmentioning

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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Thrombotic Microangiopathy Following Arabian Saw-Scaled Viper (Echis coloratus) Bite: Case Report

Cited by 6 publications

References 0 publications

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Atypical Hemolytic Uremic Syndrome in a Patient With Bothrops asper Envenomation

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

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