Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite in Sri Lanka Rathnayaka.

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Presentation transcript:

Prolonged Coagulopathy, Ecchymoses, and Microangiopathic Hemolytic Anemia Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite in Sri Lanka Rathnayaka Mudiyanselage M.K. Namal Rathnayaka, MBBS, MA, MSc in Medical Tox., Dip. in Tox. Dip. in OH&S., Senanayake A.M. Kularatne, MBBS, MD, MRCP (UK), FRCP (Lond), Anusha Nishanthi Ranathunga, MBBS, Mahinda Kumarasinghe, MBBS, MD, Jayantha Rajapakse, BVSc, PhD, Shirani Ranasinghe, BVSc, MPhil, PhD Wilderness & Environmental Medicine Volume 28, Issue 3, Pages 253-258 (September 2017) DOI: 10.1016/j.wem.2017.05.005 Copyright © 2017 Wilderness Medical Society Terms and Conditions

Figure 1 Necrosis, swelling, and blistering at the site of bite on the right foot on day 4 after snakebite. Wilderness & Environmental Medicine 2017 28, 253-258DOI: (10.1016/j.wem.2017.05.005) Copyright © 2017 Wilderness Medical Society Terms and Conditions

Figure 2 Ecchymoses on day 4 after snakebite on A, left lower back side; B, left upper arm; and C, left forearm. Wilderness & Environmental Medicine 2017 28, 253-258DOI: (10.1016/j.wem.2017.05.005) Copyright © 2017 Wilderness Medical Society Terms and Conditions

Figure 3 Microangiopathic hemolytic anemia (MAHA) found in day 4 after snakebite A, x 20, B, x 100 Image 1 acanthocytes Image 2 fragmented red blood cells (schistocytes). Wilderness & Environmental Medicine 2017 28, 253-258DOI: (10.1016/j.wem.2017.05.005) Copyright © 2017 Wilderness Medical Society Terms and Conditions

Figure 4 Spreading of ecchymoses into the right side of back on day 5 after snakebite. Wilderness & Environmental Medicine 2017 28, 253-258DOI: (10.1016/j.wem.2017.05.005) Copyright © 2017 Wilderness Medical Society Terms and Conditions

Figure 5 A, Offending snake—H. hypnale (hump-nosed pit viper), female snake 400 mm in total length. B, Note that the snout tip (hump indicated in black arrow) is not raised (vs a wart-like protuberance at the tip of the snout in H. zara and H. nepa), and has keeled costal scales (versus smooth in H. nepa). White arrow is indicated the pit organ (loreal pit), which is a characteristic feature of pit vipers, is in-between the eye and the nostril. Wilderness & Environmental Medicine 2017 28, 253-258DOI: (10.1016/j.wem.2017.05.005) Copyright © 2017 Wilderness Medical Society Terms and Conditions