The natural course of defibrination syndrome caused by Echis colorata venom (ECV) in five patients is reported. All patients developed afibrinogenemia within six hours after the bite. Concomitantly a depression in factor V was recorded. Factor VIII and thrombocyte count in blood were normal in most patients. In the light of the known effects of ECV on blood coagulation in vivo and in vitro it is concluded that the afibrinogenemia is due to intravascular clotting.
Four patients had transient renal damage, manifested by oliguria, azotemia, albuminuria and cylindruria, ascribed to microthrombi in the renal glomeruli.
After the bite, the natural course was benign, no major bleeding was observed, and all signs of coagulopathy reverted to normal within 7 days. Therefore we recommend no specific treatment for this condition. In the case of heavily bleeding patients, administration of antiserum against ECV and/or heparin should be considered.
References
1
Brown R,
Dewar M. A.
Heart damage following adder bite in England. British Heart Journal 1965; 27: 144
3
de Vries A,
Cohen I.
Hemorrhagic and blood coagulation disturbing action of snake venoms. In
Poller L.
(Ed.) Recent Advances in Blood Coagulation.. London: J. &. A Churchill; 1969: 277
5
Duke W. W.
The pathogenesis of purpura haemorrhagica with special reference to the part played by blood platelets. Archives of Internal Medicine 1912; 10: 445
9
Lorberbaum O,
Cohen I,
Joshua H,
de Vries A.
Action of Echis colorata venom on intrinsic thromboplastin generation. Israel Journal of Medical Sciences 1966; 2: 248
11
Mersky C,
Johnson A. J,
Kleiner G. J,
Wohl H.
The defibrination syndrome : Clinical features and laboratory diagnosis. British Journal of Haematology 1967; 13: 528
13
Nahas L,
Denson K. W. E,
MacFarlane R. G.
A study of the coagulant action of eight snake venoms. Thrombosis et Diathesis Haemorrhagica 1964; 12: 355
16
Ratnoff O. D,
Menzie C.
A new method for determination of fibrinogen in small samples of plasma. Journal of Laboratory and Clinical Medicine 1951; 37: 316
17
Rechnic J,
Trachtenberg P,
Casper J,
Moroz Ch,
de Vries A.
Afibrinogenemia and thrombocytopenia in guinea pigs following injection of Echis colorata venom. Blood 1962; 20: 735
21
Weiss H. J,
Allan S,
Davidson E,
Kochwa S.
Afibrinogenemia in man following the bite of a rattlesnake (Crotalus adamanteus). American Journal of Medicine 1969; 47: 625
22
Weiss H. J,
Phillips L. L,
Jopewell W. S,
Phillips G,
Christy N. P,
Nith J. F.
Heparin therapy in a patient bitten by a saw-scaled viper (Echis carinatus), a snake whose venom activates prothrombin. American Journal of Medicine 1973; 54: 653