A study on thrombotic microangiopathy spectrum disorders in snake bite

Background: Hemotoxic toxin syndrome, carry a high risk of hemorrhage and death. Snake venom have toxins that cause coagulopathy in a two different mechanism of actions. The snake toxins act as anticoagulant which inhibit clotting cascade or act as procoagulant toxins which activate the clotting cascade and consume clotting factors. The consumption coagulopathy in snake bite is referred to as Venom Induced Consumptive Coagulopathy (VICC). VICC is marked by prolonged clotting time and clotting factor deficiencies and an elevated d-dimer. VICC has a rapid onset and resolves with inactivation of toxins and synthesis of new clotting factors. A subset of VICC develops Thrombotic Microangiopathy (TMA). TMA is different and poorly understood hemotoxic syndrome.Materials and Methods: We performed a prospective analytical study of all consenting adult patients presenting to Thanjavur medical college, Tamil Nadu with suspected or with clear snake bite history within 24 hours and all Patients with thrombocytopenia less than 1.5 lakh in the first 3 days of hospital stay. All patients with Pre-existing kidney disease with serum creatinine more than 1.4 prior to snake bite and ultrasound evidence of chronic kidney disease were excluded. The study was done from January 2021 to January 2022.Results: TMA spectrum disorders, including isolated thrombocytopenia, MAHA, and renal failure, are primarily hematological and renal, with severe presentations involving thrombocytopenia, MAH, schistiocytes, and renal failure. Clinicians should monitor tests, administer ASV early, and anticipate further TMA evidence to prevent complications.Conclusion: Thrombotic microangiopathy should be anticipated in all Hemotoxic snake bite. So early recognition and appropriate management will save the patient lives.