Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Clin Toxicol (Phila). 2020 Oct;58(10):997-1003. doi: 10.1080/15563650.2020.1717509. Epub 2020 Feb 18.
Thrombotic microangiopathy (TMA) resulting in acute kidney injury (AKI) is an important complication of venomous snakebites. We aimed to describe TMA secondary to Russell's viper () and hump-nosed viper ( spp.) bites and assess the effect of different treatments. We undertook a prospective observational study of patients with AKI secondary to snakebite over a two-year period. Data recorded included: demographic details, clinical and laboratory features, treatment, complications and outcomes, until hospital discharge and at three months post-discharge. TMA was defined as the development of microangiopathic hemolytic anemia and thrombocytopenia along with AKI. Treatment with therapeutic plasma exchange (TPE; also known as plasmapheresis) and/or fresh frozen plasma (FFP) was determined by the treating clinician. Antivenom was given to all patients with evidence of systemic envenoming following Russell's viper bites. Fifty-nine patients were included in the analysis. Thirty-three (56%) were males and median age was 56 years. Forty-five (76%) developed TMA while a further 11 and two developed isolated thrombocytopenia and microangiopathic hemolytic anemia, respectively. Presence of TMA was associated with increased dialysis requirements (5 vs. 3) and longer hospital stay (18 vs. 12 days). Of the patients with TMA, nine received TPE with or without FFP infusions. The use of TPE was not associated with improved outcomes in patients with TMA based on requirement for blood transfusion, recovery of thrombocytopenia, requirement of dialysis and duration of hospital stay. Patients who did not receive TPE had better renal function at three months compared to patients who received this treatment. Presence of TMA in patients with and bites was associated with a more prolonged course of AKI. Patients with TMA who were treated with TPE did not have improved early or late outcomes compared to patients who were not treated with TPE.
血栓性微血管病（TMA）导致急性肾损伤（AKI）是毒蛇咬伤的重要并发症。我们旨在描述由罗素蝰蛇（）和尖吻蝮（ spp.）咬伤引起的 TMA，并评估不同治疗方法的效果。我们在两年期间对 AKI 继发于蛇咬伤的患者进行了前瞻性观察研究。记录的数据包括：人口统计学细节、临床和实验室特征、治疗、并发症和结局，直至出院和出院后三个月。TMA 的定义是微血管性溶血性贫血和血小板减少症合并 AKI 的发展。治疗性血浆置换（TPE；也称为血浆置换）和/或新鲜冷冻血浆（FFP）的使用由主治医生决定。所有出现全身中毒症状的罗素蝰蛇咬伤患者均给予抗蛇毒血清。共纳入 59 例患者进行分析。33 例（56%）为男性，中位年龄为 56 岁。45 例（76%）发生 TMA，另有 11 例和 2 例分别发生孤立性血小板减少症和微血管性溶血性贫血。TMA 的存在与透析需求增加（5 例 vs. 3 例）和住院时间延长（18 天 vs. 12 天）相关。在发生 TMA 的患者中，9 例接受 TPE 联合或不联合 FFP 输注。根据输血需求、血小板减少症恢复、透析需求和住院时间长短，TPE 的使用与 TMA 患者的结局改善无关。未接受 TPE 治疗的患者在 3 个月时肾功能较好。 和 咬伤患者的 TMA 存在与 AKI 病程延长有关。与未接受 TPE 治疗的患者相比，接受 TPE 治疗的 TMA 患者的早期和晚期结局并未改善。
