Severe Pediatric Snakebite With Coagulopathy and Compartment Syndrome: Conservative Management With Plasma Exchange

Area of Science:

• Toxicology
• Pediatric Hematology
• Emergency Medicine

Background:

• Snakebite envenomation is a significant global health issue, particularly in rural areas.
• Hemotoxic snakebites can cause life-threatening coagulopathy, hemolytic anemia, and compartment syndrome.
• Pediatric cases present unique challenges due to smaller body mass and potential for rapid deterioration.

Purpose of the Study:

• To report a case of severe hemotoxic snakebite envenomation in a child.
• To highlight the effectiveness of therapeutic plasma exchange (TPE) in refractory pediatric cases.
• To discuss the management of compartment syndrome in the context of uncontrolled coagulopathy.

Main Methods:

• Case report of a 6-year-old boy with severe hemotoxic snakebite.
• Initial management included antivenom and supportive transfusion therapy.
• Subsequent treatment involved five sessions of therapeutic plasma exchange due to persistent deterioration.
• Conservative management of suspected compartment syndrome was employed due to high bleeding risk.

Main Results:

• The patient developed venom-induced consumption coagulopathy, hypofibrinogenemia, thrombocytopenia, and microangiopathic hemolytic anemia.
• Antivenom and transfusions were insufficient to correct coagulopathy and anemia.
• Therapeutic plasma exchange led to stabilization of hematologic parameters and resolution of limb swelling.
• Limb function was preserved without surgical intervention for compartment syndrome.

Conclusions:

• Therapeutic plasma exchange is a valuable treatment for pediatric snakebite envenomation unresponsive to conventional therapies.
• Conservative management of compartment syndrome may be appropriate in high-risk bleeding scenarios.
• Early recognition, multidisciplinary care, and advanced treatments like TPE are crucial for complex pediatric envenomations.