Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Intensive Care Unit, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China.
Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China.
Wilderness Environ Med. 2021 Sep;32(3):344-350. doi: 10.1016/j.wem.2021.02.009. Epub 2021 Jul 20.
Bees and wasps (order Hymenoptera) are commonly encountered worldwide and often deliver defensive stings when in contact with humans. Massive envenomation resulting from >50 stings causes a toxic reaction and life-threatening complications that typically result in rhabdomyolysis and disseminated intravascular coagulation. Two male patients who were stung over 80 times by wasps experienced severe coagulation abnormality. Consecutive examination by thromboelastography (TEG) guided by heparinase treatment during their hospitalization evidenced heparin-like coagulation dysfunction despite no clinical use of heparin-like substances. Numerous tests were also conducted to confirm whether the coagulation abnormalities could be attributed to hyperendogenous heparinization and allergic reaction, rhabdomyolysis, and vascular endothelial cell injury without apparent disseminated intravascular coagulation, which might all be affected by the production of endogenous heparin. The reduced coagulation potential caused by hyperendogenous heparinization was associated with the binding of antithrombin and the activation of fibrinolysis. In addition, TEG-identified coagulopathy was moderated using protamine for heparin neutralization. The massively envenomed patients survived and were discharged after completion of medical care. We also review clinical manifestations from other published case reports, including topical treatment. Our study provides clinical evidence and guidance for diagnosis via TEG and appropriate intervention with protamine for patients with massive wasp envenomation.
蜜蜂和黄蜂（膜翅目）在世界范围内很常见，当与人类接触时，它们通常会进行防御性蜇刺。超过 50 次蜇刺会导致大量毒液中毒，产生危及生命的并发症，通常导致横纹肌溶解和弥散性血管内凝血。两名男性患者被黄蜂蜇了 80 多次，出现严重的凝血异常。在住院期间，通过肝素酶治疗指导进行连续血栓弹力图（TEG）检查，尽管没有临床使用肝素样物质，但仍存在肝素样凝血功能障碍。还进行了大量测试，以确认凝血异常是否归因于内源性肝素化和过敏反应、横纹肌溶解和血管内皮细胞损伤，而没有明显的弥散性血管内凝血，这些都可能受到内源性肝素的产生的影响。由于内源性肝素化导致的凝血功能降低与抗凝血酶结合和纤维蛋白溶解激活有关。此外，使用鱼精蛋白中和肝素可调节 TEG 确定的凝血异常。大量中毒的患者在完成治疗后存活并出院。我们还回顾了其他已发表的病例报告中的临床表现，包括局部治疗。我们的研究为 TEG 诊断和对大量黄蜂蜇伤患者进行适当的鱼精蛋白干预提供了临床证据和指导。
