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

Zain Mohammed Al Muqbel1, Abdulrahman Al-Majmuei2, Ali Haider Ali1

  • 1Salmaniya Medical Complex Manama Bahrain.

Clinical Case Reports
|June 29, 2026
PubMed

Insights

Severe snakebite envenomation in a child caused coagulopathy and anemia. Therapeutic plasma exchange stabilized the patient when conventional treatments failed, preserving limb function.

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.

Keywords:
case reportcompartment syndromedisseminated intravascular coagulation (DIC)pediatric envenomationsnakebitetherapeutic plasma exchangevenom‐induced consumption coagulopathy (VICC)

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