Thrombotic microangiopathy in two tiger snake envenomations

Thrombotic microangiopathies are a rare group of disorders with features such as microangiopathic haemolytic anaemia, thrombocytopenia and renal failure. Thrombotic microangiopathy has been previously reported in association with envenomation from a number of snake species. We present the first two reported cases of thrombotic microangiopathy caused by envenomation from the common tiger snake (Notechis scutatus). Both patients had classical features of thrombotic microangiopathy with microangiopathic haemolytic anaemia, thrombocytopenia and renal failure commencing in the first 48 hours after envenomation. The presentations and recovery were similar to case presentations of other snakebite envenomation associated thrombotic microangiopathies. Normal ADAMTS13 activity suggests that plasmapharesis may not be beneficial, although this needs further investigation.