Strydom Morné A, Bester Janette, Mbotwe Sthembile, Pretorius Etheresia
Department of Physiology, University of Pretoria, South Africa.
Sci Rep. 2016 Oct 24;6:35988. doi: 10.1038/srep35988.
A significant burden of illness is caused globally by snakebites particularly by the puff adder, Bitis arietans. Presently there is no reliable and rapid method to confirm envenomation on blood chemistry; although coagulation parameters like prothrombin time, partial thromboplastin time, international normalized ratio and also serum electrolytes are tested. Here, we found that direct in vitro exposure of physiological relevant whole venom levels to human healthy blood (N = 32), caused significant physiological changes to platelet activity using a hematology analyzer, and measuring occlusion time, as well as lyses time, with the global thrombosis test (GTT). Disintegrated platelets were confirmed by scanning electron microscopy (SEM). We also confirmed the pathologic effects on erythrocytes (RBCs) (visible as eryptotic RBCs), by looking at both light microscopy and SEM. Thromboelastography showed that no clot formation in whole blood could be induced after addition of whole venom. We propose further clinical studies to investigate the use of light microscopy smears and hematology analyzer results immediately after envenomation, as a possible first-stage of clinical confirmation of envenomation.
全球范围内，蛇咬伤尤其是鼓腹咝蝰（Bitis arietans）咬伤造成了巨大的疾病负担。目前，尚无可靠且快速的方法通过血液化学检查来确认是否中毒；尽管会检测凝血酶原时间、活化部分凝血活酶时间、国际标准化比值等凝血参数以及血清电解质。在此，我们发现，使用血液分析仪并通过全局血栓形成试验（GTT）测量闭塞时间和溶解时间，将生理相关的全毒液水平直接体外暴露于人类健康血液（N = 32）中，会导致血小板活性发生显著生理变化。通过扫描电子显微镜（SEM）确认了血小板的解体。通过光学显微镜和SEM观察，我们还证实了对红细胞（RBC）的病理影响（表现为凋亡红细胞）。血栓弹力图显示，加入全毒液后无法诱导全血形成凝块。我们建议进一步开展临床研究，以调查在中毒后立即使用光学显微镜涂片和血液分析仪结果，作为中毒临床确认的可能第一阶段。
