Prevalence of Thrombotic Microangiopathy Among Patients With Snake Bite-Induced Hemotoxic Clinical Syndrome in the Hills of Himachal Pradesh, India

Abstract

Objective: Snakebite envenomation-related thrombotic microangiopathy (TMA) is observed in a subset of patients with venom-induced consumption coagulopathy (VICC). The study was planned to determine the prevalence of TMA among patients with hemotoxic envenomation admitted to a medical college hospital in Himachal Pradesh, India. Methods: This was a hospital-based open cohort observational study conducted on patients diagnosed with hemotoxic envenomation. The study period was of 1 year and patients were recruited using a nonprobability sampling method. Hemotoxic envenomation was defined as prolonged bedside 20-min whole blood clotting time (20 WBCT) following a history of snake bites. TMA was defined as the triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI). Results: A total of 56 patients (32 females and 24 males) were included in the study. The prevalence of TMA was (7/56) 12.5%. Out of the seven patients with TMA, four (57.1%) patients improved without renal replacement therapy and three (42.9%) patients took referrals for getting nephrology services outside the state and hence were lost in follow-up. AKI was developed in 17 (30%) patients. Conclusion: The study demonstrated that TMA is not an uncommon entity. Investigation protocol for TMA should be included in all patients with VICC.

Keywords

• acute kidney injury
• hemolytic anemia
• schistocytes
• snake bite
• thrombocytopenia