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Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 475–482 | Cite as

Thrombotic microangiopathy in hematotoxic snakebites and its impact on the prognosis: an entity often overlooked

  • Ganesh MohanEmail author
  • Pruthvi Raj Guduri
  • Shamee Shastry
  • Dhivya Kandasamy
Article

Abstract

Snakebite associated thrombotic microangiopathy (TMA) is a spectrum of disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury (AKI). We carried out this study to find out the prevalence of TMA in hematotoxic snake envenomation and to analyze its impact on the clinical outcome of patients. Retrospective data were collected from the medical records, hospital and lab information system after institutional ethics committee approval. Hematotoxic snake bite patients were categorized into Group 1 (with TMA) and Group 2 (without TMA). Chi square test, Mann–Whitney ‘U’ test and Odd’s ratio (OR) were used for statistical analysis. Out of 331 snakebite cases admitted, 202 (64.33%) were hematotoxic envenomation with a mean age of 42.26 ± 15.61. Majority were males with a male to female ratio of 2.01:1. Lower limb was the most common site of bite (59.9%). The prevalence of coagulopathy, TMA and AKI observed was 56.4, 18.8 and 37.6% respectively. AKI had a significant risk of undergoing hemodialysis when it was associated with TMA (r = 0.635, OR = 19.3182, P < 0.0001). Higher number of patients in Group 1 received more blood products (r = 0.406, OR = 8.525, P < 0.0001). Prolonged hospital stay (17.25 ± 12.23 vs. 8.86 ± 7.18 days, P < 0.0001) and higher complication rates were (33.33% vs. 11.4%, P < 0.0048) observed in patients with TMA. Snakebite associated TMA has a significant impact on the prognosis and understanding the pathophysiology of this entity will help to formulate guidelines.

Keywords

Hematotoxic snakebite Thrombotic microangiopathy India Pathophysiology of snakebite associated TMA Therapeutic guidelines 

Notes

Author contribution

GM—The concept of this study, Formulated the study design, performed the study, Data analysis and Manuscript preparation. GPR—Data collection. SS—Interpretation of Data, Critical review and final approval of the manuscript. DK—Data analysis and review of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Immunohematology and Blood Transfusion, Kasturba Medical College, ManipalManipal Academy of Higher EducationManipalIndia
  2. 2.Department of Transfusion Medicine, OPD BlockJIPMER Hospital CampusPuducherryIndia

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