Nielsen Vance G, Boyer Leslie V
aDepartment of Anesthesiology bVIPER Institute, The University of Arizona College of Medicine, Tucson, Arizona, USA.
Blood Coagul Fibrinolysis. 2016 Jul;27(5):506-10. doi: 10.1097/MBC.0000000000000440.
Hypofibrinogenemia is an important clinical consequence following envenomation by Crotalus species, usually attenuated or prevented by administration of antivenom. It has been determined that iron and carbon monoxide (CO) enhance fibrinogen as a thrombin substrate, likely secondary to conformational changes in molecular structure. We tested the hypothesis that pretreatment of plasma with iron and CO could attenuate the effects of exposure to Crotalus atrox venom. Human plasma was exposed to 0 to 10 μmol/l ferric chloride (iron source) and 0 to 100 μmol/l CO-releasing molecule-2 (CO source) followed by exposure to 0 to 0.5 μg/ml venom for 5 to 20 min. Changes in coagulation kinetics were determined with thrombelastography. Iron and CO significantly attenuated venom-mediated degradation of plasmatic coagulation in terms of onset time, velocity of clot growth and final clot strength. Further preclinical investigation of iron and CO administration as a 'bridge-to-antivenom' to preserve plasmatic coagulation is justified.
低纤维蛋白原血症是被响尾蛇属物种咬伤后的一个重要临床后果，通常通过注射抗蛇毒血清来减轻或预防。已经确定，铁和一氧化碳（CO）可增强纤维蛋白原作为凝血酶底物的作用，这可能继发于分子结构的构象变化。我们检验了以下假设：用铁和CO预处理血浆可减轻暴露于墨西哥矛头蝮蛇毒的影响。将人血浆暴露于0至10微摩尔/升的氯化铁（铁源）和0至100微摩尔/升的CO释放分子-2（CO源），然后再暴露于0至0.5微克/毫升的蛇毒中5至20分钟。用血栓弹力图测定凝血动力学的变化。就起始时间、血凝块生长速度和最终血凝块强度而言，铁和CO显著减轻了蛇毒介导的血浆凝血降解。将铁和CO作为“抗蛇毒血清桥梁”以维持血浆凝血进行进一步的临床前研究是合理的。
