Hemostatic disturbances observed in patients with snakebite in south China

Abstract

To investigate the hematological disorders after snakebite, we measured the maximum platelet aggregation rate (MAR), antithrombin III (AT-III) activity, α 2-plasmin inhibitor (α 2-PI) activity, concentration of fibrinogen (Fg) and fibrin degradation products (FDP) in 25 samples from 17 patients with snakebite in south China. The results obtained in the patients before application of antivenom and patients with Ophiophagus hannah ( Oh.) bite were as follows: (1) the mean MAR values were significantly decreased in the case of the snakebites from Vipera russellii ( Vr.) and Trimeresurus mucrosquamatus ( Tm.); (2) the mean activities of AT-III were decreased in all patients in the present study; 3) the mean activities of α 2-PI were significantly decreased in patients bitten by Deinagkistrodon acutus ( Da.), Agkistrodon halys ( Ah.), Vr., Trimeresurus stejnegeri ( Ts.), Tm. and Naja naja atra ( Nn.); (4) the mean concentrations of Fg were markedly decreased in patients bitten by Da., Ah., Vr., Ts. and Tm.; and (5) the mean levels of FDP were significantly increased in cases of Da., Vr. and Ts. bite, but not in Ah., Tm., Nn. and Oh. bite. The results of the present study indicate that disorders of platelet aggregation and the coagulation–fibrinolysis system are liable to occur in patients with snakebite from Da., Ah., Vr., Ts., Tm. and Nn. Furthermore, it appeared that disseminated intravascular coagulation (DIC) was evoked in some patients. Specific antivenom was found to be useful for improving the hemostatic disturbances after snakebite from Ah. and Nn.