Venom-Induced Consumption Coagulopathy Unresponsive to Antivenom After Echis carinatus sochureki Envenoming

A snake breeder, 47-years-old man, was bitten by the saw-scaled viper (Echis carinatus sochureki). After admission to Toxinology Centre, within 1.5 h, laboratory evaluation showed clotting times prolonged to non-measurable values, afibrinogenaemia, significantly elevated D-dimers, haemolysis and myoglobin elevation. Currently unavailable antivenom was urgently imported and administered within 10 hours. In 24 hours, oligoanuric acute kidney injury (AKI) and mild acute respiratory distress syndrome (ARDS) developed. Despite administration of 10 vials of urgently imported Polyvalent Snake Antivenom Saudi Arabia, the venom-induced consumption coagulopathy (VICC) and AKI persisted. Another ten vials of antivenom were imported from abroad. VICC slowly subsided during the antivenom treatment and disappeared after administration of total 20 vials during 5 day period. No signs of haemorrhage were present during treatment. After resolving VICC, patient was transferred to Department of Nephrology for persisting AKI and requirement for haemodialysis. AKI completely resolved after 20 days. Despite rather timed administration of appropriate antivenom, VICC and AKI developed and the quantity of 20 vials was needed to cease acute symptoms of systemic envenoming. The course illustrates low immunogenicity of the venom haemocoagulation components and thus higher requirements of the antivenom in similar cases.

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Thrombotic microangiopathy following saw-scaled viper (Echis carinatus) envenoming in Sri Lanka

SAGE Open Medical Case Reports ◽

10.1177/2050313x211032399 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110323

Author(s):

Selladurai Pirasath ◽

Chandrakulasegeran Athirayan ◽

Dilani Gajan

Keyword(s):

Sri Lanka ◽

Thrombotic Microangiopathy ◽

Clinical Manifestations ◽

Supportive Therapy ◽

Kidney Injury ◽

Medical Professional ◽

Consumption Coagulopathy ◽

Venomous Snake ◽

Rare Manifestation ◽

Echis Carinatus

The saw-scaled viper ( Echis carinatus) is considered as a highly venomous snake in Sri Lanka. The clinical manifestations are localized pain and swelling, coagulopathy and renal impairment. Thrombotic microangiopathy is rarely reported as a complication of saw-scaled viper envenoming. The clinical manifestations of thrombotic microangiopathy include thrombocytopenia, microangiopathic haemolytic anaemia and acute kidney injury. The consumption coagulopathy of post-envenoming could be followed by a syndrome consistent with thrombotic microangiopathy. We describe a patient with thrombotic microangiopathy following saw-scaled viper systemic envenoming which was managed with antivenom and supportive therapy. The dead snake which was brought by patient was identified by medical professional as saw-scaled viper ( E. carinatus) based on morphological features. This case illustrates a rare manifestation thrombotic microangiopathy following saw-scaled viper envenoming.

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An approach of the plant Mesua Ferrea Linn for the venom induced consumption coagulopathy (VICC), caused by the snake Echis Carinatus (Russel viper)

International Journal of Pharmaceutical Research ◽

10.31838/ijpr/2021.13.01.173 ◽

2020 ◽

Vol 13 (01) ◽

Keyword(s):

Consumption Coagulopathy ◽

Echis Carinatus

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Fibrin Derivatives, Plasma Hemoglobin and Glomerular Fibrin Deposition in Experimental Intravascular Coagulation

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647778 ◽

1973 ◽

Vol 29 (02) ◽

pp. 363-374 ◽

Cited By ~ 11

Author(s):

F. K Beller ◽

W Theiss

Keyword(s):

Quantitative Measurement ◽

Plasma Fibrinogen ◽

Moderate Increase ◽

Consumption Coagulopathy ◽

Fibrin Deposition ◽

Intravascular Coagulation ◽

Plasma Hemoglobin ◽

Three Stages ◽

Two Parameters ◽

Gelation Test

SummaryPlasma fibrinogen, circulating fibrinmonomers (as indicated by a positive ethanol gelation test), fibrinolysis breakdown products and plasma hemoglobin were assayed in 122 rats subjected to endotoxin injection or infusion. The results were correlated with the quantitative measurement of glomerular fibrin deposition. Based on these data four groups were determined : consumption coagulopathy and three stages of increasing severity of disseminated intravascular coagulation (DIG).Consumption coagulopathy was defined by a decrease in plasma fibrinogen and a positive ethanol gelation test in the absence of glomerular fibrin deposition. Plasma hemoglobin and fibrinolysis breakdown products were normal or only slightly increased.DIG as characterized by glomerular fibrin deposition was defined as moderate (1 to 20% glomeruli showing fibrin strands), intermediate (21 to 80%), and severe (81 to 100%). Decrease in plasma fibrinogen and frequence of a positive ethanol gelation test in all stages of DIG were only slightly different from the findings in consumption coagulopathy. However, a sharp increase in plasma hemoglobin levels was noted when glomerular fibrin deposition did occur even in small amounts. At this time only a moderate increase was noted in fibrin(ogen) breakdown products. These two parameters increased only slightly in the group of intermediate DIG. Severe DIG was characterized by a massive increase in fibrin (ogen) breakdown products and high levels of plasma hemoglobin.

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Consumption of Hageman Factor Activity in the Generalized Shwartzman Reaction Induced by Liquoid

Thrombosis and Haemostasis ◽

10.1055/s-0038-1654150 ◽

1970 ◽

Vol 23 (02) ◽

pp. 386-404 ◽

Cited By ~ 6

Author(s):

G Müller-Berghaus ◽

H. G Lasch

Keyword(s):

Partial Thromboplastin Time ◽

Lethal Dose ◽

Control Group ◽

Factor V ◽

Consumption Coagulopathy ◽

Factor Activity ◽

Hageman Factor ◽

Intravascular Coagulation ◽

Shwartzman Reaction

SummaryThe role of Hageman factor in triggering intravascular coagulation has been studied in rabbits injected intravenously with Liquoid. Besides changes of coagulation parameters characteristic of consumption coagulopathy (e.g. decrease in platelet counts, fibrinogen levels, factor V activity), a pronounced drop in Hageman factor activity was observed after injection of Liquoid. Likewise, the partial thromboplastin time became prolonged.The activation of Hageman factor in vivo could be prevented by intravenous infusion of lysozyme. Twenty min after starting the lysozyme infusion, the partial thromboplastin time became prolonged from a mean of 29 sec to 108 sec. Animals infused with lysozyme and injected with a lethal dose of Liquoid did not develop a consumption coagulopathy. In the same manner, none of 10 animals treated with lysozyme developed the generalized Shwartzman reaction, whereas in the control group 19 out of 20 animals showed fibrin thrombi in the glomerular capillaries.From the present study it may be concluded that the intravascular coagulation process after intravenous injection of Liquoid is triggered by Hageman factor activation.

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Factor II Related Antigen and Antithrombin III Levels as Indicators of Liver Failure in Consumption Coagulopathy

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657171 ◽

1982 ◽

Vol 47 (03) ◽

pp. 218-220 ◽

Cited By ~ 13

Author(s):

P Sié ◽

E Letrenne ◽

C Caranobe ◽

M Genestal ◽

B Cathala ◽

...

Keyword(s):

Liver Failure ◽

Antithrombin Iii ◽

Coagulation Factors ◽

Consumption Coagulopathy ◽

Blood Coagulation Factors ◽

Factor Ii ◽

At Iii ◽

Group A ◽

Group B

SummaryIn order to detect impaired synthesis of blood coagulation factors associated to consumption coagulopathy, a simultaneous evaluation of factor II-related antigen (II rAg) and of antithrombin III (AT III) was carried out in 16 patients affected with severe defibrination. An in vitro preliminary study on plasma and serum demonstrated that the levels of II rAg and of AT III, assessed by the Laurell technique with Behring antisera, were not reduced by the coagulation process. The patients were, a posteriori, classified into two groups according to the absence (group A) or the presence (group B) of factors predisposing to liver failure such as metastasis, cirrhosis, and prolonged shock. II rAg and AT III levels are significantly correlated; they are in the normal range in group A but reduced in group B. Thus II rAg or AT III level determinations are useful markers in the detection of liver failure associated to the consumption phenomenon. These results also suggest that part of the decreased AT III levels reported in severe cases of disseminated intravascular coagulation may be the consequence of an associated liver failure.

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Evidence for Impaired Hepatic Vitamin K1 Metabolism in Patients Treated with N-Methyl-Thiotetrazole Cephalosporins

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661101 ◽

1984 ◽

Vol 51 (03) ◽

pp. 358-361 ◽

Cited By ~ 78

Author(s):

H Bechtold ◽

K Andrassy ◽

E Jähnchen ◽

J Koderisch ◽

H Koderisch ◽

...

Keyword(s):

Protein C ◽

Oral Intake ◽

Bleeding Complications ◽

Side Chain ◽

Acute Administration ◽

Vitamin K1 ◽

New Class ◽

Parenteral Alimentation ◽

Hepatocellular Regeneration ◽

Echis Carinatus

SummaryIn 8 patients on no oral intake and with parenteral alimentation, administration of cephalosporins with N-methyl-thiotetrazole side chain (moxalactam, cefamandole), was associated with prolongation of prothrombin time, appearance in the circulation of descarboxy-prothrombin (counter immunoelectrophoresis and echis carinatus assay) and diminution of protein C. Acute administration of 10 mg vitamin Ki was followed by the transient appearance of vitamin K1 2,3-epoxide, indicating an impaired hepatocellular regeneration of vitamin K1 from the epoxide. Impaired hepatic vitamin K1 metabolism, tentatively ascribed to the N-methyl-thiotetrazole group, is one (but possibly not the only) cause of bleeding complications and depression of vitamin K1dependent procoagulants in patients treated with the new class of cephalosporins.

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Hemangiomatosis of the greater omentum – a case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.178-180 ◽

2019 ◽

Vol 98 (4) ◽

pp. 178-180

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Histological Examination ◽

Case Reports ◽

Greater Omentum ◽

Surgical Removal ◽

Consumption Coagulopathy ◽

Cavernous Hemangiomas ◽

Mesodermal Origin ◽

Benign Tumours

Cavernous hemangiomas are benign tumours of mesodermal origin. Even though various localizations of hemangioma have been described in the literature, its occurrence in the greater omentum is very rare. Only symptomatic hemangiomas are indicated for surgical treatment. There are case reports presenting resection or surgical removal of the greater omentum with hemangioma because of mechanical syndrome, consumption coagulopathy, bleeding, infection or suspicion of a malignancy. This article presents a case report of a patient operated on for a suspicion of carcinomatosis of the greater omentum. Histological examination found hemangiomatosis in the resected greater omentum.

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Study of Haemostasis in Schoenlein-Henoch’s Syndrome

10.1055/s-0039-1689507 ◽

1975 ◽

Cited By ~ 1

Author(s):

Gy. Boros ◽

J. Sámik ◽

Ljubov Gofman ◽

Judit Nagv ◽

Gy. Deák ◽

...

Keyword(s):

Electron Microscopy ◽

Light Microscopy ◽

Blood Coagulation ◽

Fibrinolytic Activity ◽

Capillary Permeability ◽

Thrombin Time ◽

Consumption Coagulopathy ◽

Fibrin Deposition ◽

Coagulation Defect ◽

Capillary Resistance

Blood coagulation, thrombocyte function and capillary resistance were studied in 21 adult patients with Schoenlein-Henoch’s syndrome. 20 different tests were carried out at different stages of the disease. In 2 cases skin, in 1 mesocolon and in 10 kidneys were examined histologicaly (light microscopy, immunofluorescence, electron microscopy).Capillary permeability was increased at least once in every patient. All patients but 2 were characterized by hypercoagulability. In addition to thrombotic changes, an increase in labile fibrinogen was detected in the serum of 12 patients, and thrombin time was prolonged in 11 patients on 31 occasions. Plasma fibrinolytic activity was increased in 11 patients. Fibrin deposition was demonstrable in the skin of 2 in the mesocolon of 1 and in the kidneys of 7 patients.It is suggested that besides the capillaropathy a coagulation defect, resembling consumption coagulopathy is a characteristic of Schoenlein-Henoch’s syndrome.

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