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Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice
Tina Noutsos1,2, Bart J Currie1,2, Eranga S Wijewickrama3,4
1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia.
Toxins
|January 20, 2022
Summary
Snakebite can cause thrombotic microangiopathy (TMA), a serious condition characterized by anemia and low platelets. Early snakebite treatment is crucial, but antivenom doesn't specifically prevent TMA, and plasma exchange is ineffective.
Area of Science:
- Toxicology
- Hematology
- Nephrology
Background:
- Snakebite envenoming is a major global health concern.
- Venom-induced consumption coagulopathy (VICC) can lead to hemorrhage and thrombotic microangiopathy (TMA).
Purpose of the Study:
- To review current evidence on snakebite-associated TMA.
- To discuss epidemiology, diagnosis, outcomes, and interventions for snakebite-associated TMA.
Main Methods:
- Literature review of recent evidence on snakebite-associated TMA.
- Analysis of diagnostic criteria, clinical presentation, and treatment effectiveness.
Main Results:
- Snakebite-associated TMA involves microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI).
- Proposed diagnostic criteria include anemia with schistocytes, thrombocytopenia, or a significant drop in platelet count.
- Most patients survive AKI, but long-term chronic kidney disease risk necessitates follow-up.
Conclusions:
- Early antivenom is essential for snake envenoming but does not specifically prevent TMA.
- Therapeutic plasma exchange has shown no proven efficacy for snakebite-associated TMA.
- Long-term monitoring is recommended for patients at risk of chronic kidney disease.
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