Mechanisms of echinocytosis induced by Crotalus atrox venom

Transient echinocytosis has been reported in association with snake envenomation in humans and dogs. An in vitro model of echinocytosis induced by venom of crotalus atrox (western diamondback rattlesnake) was established to characterize erythrocyte morphologic changes and to investigate potential mechanisms of echinocytic transformation. Erythrocyte morphologic changes produced after the addition of venom to canine, feline, equine, and human blood were characterized by dose-dependent echinocytosis. Type III echinocytosis were consistently induced in vitro at a dose comparable to in vivo envenomation; higher venom doses produced spheroechinocytic and spherocytic transformations. The changes could not be induced in vitro in the presence of ethylenediaminetraacetic acid but were observed in heparinized and citrated blood samples, suggesting the participation of calcium or a metalloprotein in echinocytic change. These findings suggest that phospholipase A2 (PLA2), a calcium-dependent enzyme in snake venom, may be responsible for echinocytic transformation via the production of lysolecithin, a known echinocytic agent. Purified PLA2 from C. atrox venom induced dose-dependent echinocytic change in vitro in canine blood. Other potential mechanisms of echinocytic change evaluated in canine blood included erythrocyte cation loss and erythrocyte ATP depletion. In canine blood mixed with venom, erythrocyte sodium and potassium concentrations were consistently less than those of controls, likely as a result of membrane alteration produced by the actions of PLA2. There was no difference in blood ATP concentrations from dogs with snakebite when compared with normal controls; however, the power of this comparison was low. Echinocytosis induced by rattlesnake venom is related to the degree of venom exposure and may correlate clinically with the amount of venom absorbed. Echinocytic transformation in vitro is induced by PLA2 present in venom.