Hemoperfusion as Adjunctive Therapy in Severe Snake Envenomation Refractory to Antivenom: A Case Series

Snake envenomation remains a significant cause of morbidity worldwide, with antivenom serving as the cornerstone of treatment. This case series describes outcomes of three male patients (ages 34-63 years) with severe envenomation who demonstrated progressive local swelling and coagulopathy despite receiving at least 15 vials of antivenom. All received adjunctive hemoperfusion using a Nipro HA230 cartridge via femoral venous access (six two-hour sessions over three days). All patients survived and were discharged after 4-5 days with normalized coagulation parameters and resolved swelling. No hemoperfusion-related complications were documented. Total antivenom ranged from 15 to 25 vials. These findings suggest hemoperfusion may be a feasible adjunctive therapy in refractory cases, though the observational design precludes definitive conclusions. Hemoperfusion should be considered experimental, reserved for severe refractory cases in well-resourced settings.