Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Toxins

Geoffrey K. Isbister¹  Bart J. Currie²  Tina Noutsos²  Eranga S. Wijewickrama³ 

[1] Clinical Toxicology Research Group, University of Newcastle, Newcastle 2308, Australia;Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia;National Hospital of Sri Lanka, University Medical Unit, Colombo 008000, Sri Lanka;

关键词: snakes;    snakebite;    venom;    thrombotic microangiopathies;    acute kidney injury;    hemolysis;   

DOI  :  10.3390/toxins14010057

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown