埃及国家环境和临床毒理学研究中心使用浆细胞疗法和皮质类固醇成功治疗严重无反应的蛇咬伤:病例报告

M. M. Fouad, N. Zawilla, Aiesha Ashraf Abdelsamie, Marie Manawil, Rehab Shehata Abdelhady Shehata, R. S. Mohammed, E. Khalifa, Mona Abdallah Ramadan, B. Mourad
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引用次数: 0

摘要

蛇咬伤是一个重要的公共卫生问题,其中毒液诱发的消耗性凝血病是一种常见的严重并发症,它是由蛇毒素激活凝血途径而导致的。我们报告了一名 56 岁的男性患者,他被认为左脚被蛇咬伤。他被送往附近的一家医院,在那里接受了镇痛剂和 3 瓶蛇多价抗蛇毒血清,12 小时后被送往我院。他的左脚出现了 2 个小的穿刺伤口、疼痛、水疱和水肿。第 2 天,患者出现牙龈出血和血尿。入院时的实验室检查显示,凝血酶原时间(PT)超过 3 分钟,凝血酶原浓度(PC)低于 2.5%,国际标准化比值(INR)为 23.43。尿液的进一步检查显示有超过 100 个红细胞。尽管在 3 天内接受了 16 袋 VACSERA 生产的血浆和 40 瓶蛇形多价抗蛇毒血清,但血红蛋白浓度和血小板计数随着黄疸的出现而下降,乳酸脱氢酶为 520,网织红细胞为 3.5%。PT超过300秒,INR仍超过范围。患者住院 6 天后出院。本病例报告表明,在治疗对抗蛇毒血清无反应的蛇咬伤患者时,血浆置换和皮质类固醇是临床上有效的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Successful Management of Severe Unresponsive Snake Bite Envenomation Using Plasmapheresis and Corticosteroid at Egyptian National Environmental and Clinical Toxicology Research Center: A Case Report
Snakebite is a significant public health issue in which venom-induced consumption coagulopathy is a common and serious complication that results from the activation of the coagulation pathway by snake toxins. We report a male patient, 56 y old, who was thought to have been bitten by a snake on his left foot. He was transported to a nearby hospital where he received analgesics and 3 snake polyvalent antivenom vials, and then he was transported to our hospital after 12 h. He presented with 2 small puncture wounds, pain, blistering, and edema of the left foot. On the 2nd day, the patient developed gingival bleeding and hematuria. Laboratory investigations upon admission revealed prothrombin time (PT) of more than 3 min, prothrombin concentration (PC) of less than 2.5%, and an international normalized ratio (INR) of 23.43. Further investigation of urine showed more than 100 RBCs. Despite receiving 16 packs of plasma and 40 snake polyvalent antivenom vials manufactured by VACSERA over 3 days, hemoglobin concentration and platelet count decreased with the appearance of jaundice, lactate dehydrogenase was 520, and reticulocytes were 3.5%. PT was more than 300 s, and INR was still over range. Plasmapheresis and corticosteroids were provided, which improved the patient’s general condition, PT, PC, and INR, and the patient was discharged after 6 days of hospital stay. This case report indicated that plasmapheresis and corticosteroids were clinically efficient approaches in the management of snake envenomation unresponsive to antivenom.
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