背景:在90年代后期,Bond和Burkhardt描述了由Crotalushordus引起的严重血小板减少现象。尽管施用了血小板和抗蛇毒血清,这种血小板减少仍然存在。关于这种血小板减少症的临床意义和解决时间的问题仍然存在。此外,由于北美有新的抗蛇毒血清,对当前治疗的反应没有很好的报道。这项研究的目的是提供进一步的见解,以治疗Crotalushoridus毒。
方法:本报告回顾性分析了21例被假定为C.hordus感染的病例。收集的数据包括年龄,性别,抗蛇毒血清管理,实验室数据,住院时间,服用血液制品,和一般临床课程。我们还评估了抗蛇毒血清的血小板反应,出血结果,和毒气引起的并发症。
结果:患者年龄为19至71岁。所有患者都是男性。大多数患者出现血小板减少症,并且都有肢体肿胀。患者最初对抗蛇毒血清治疗有反应,然而随后出现了严重的血小板减少症,包括14例血小板计数小于20×10(Tu,1991)/L.血栓弹力图(TEG)异常与血小板减少症同时出现。尽管施用了Crotalidae多价免疫Fab或Crotalidae免疫F(ab')2,但患者仍表现出持续的血小板减少症。从注射开始,反弹血小板计数大于20×109/L的中位时间为10天(6-12天)。并发症包括一名患者的部分手指截肢,四名患者牙龈出血,两个病人的血便,一名患者的鼻血输出。无患者需要输注红细胞,无死亡病例。
结论:治疗C.hordus的从业者应认识到严重血小板减少症的可能性及其持续存在,尽管有抗蛇毒血清。他们应该建议患者适当放弃可能导致创伤的活动,以及对重复实验室研究进行随访以确保血小板减少症的解决的重要性。
BACKGROUND: In the late nineties, Bond and Burkhardt described a severe thrombocytopenic phenomenon from envenomation by Crotalus horridus. This thrombocytopenia persisted despite administration of platelets and
antivenom. Questions remain regarding the clinical significance and time to resolution of this thrombocytopenia. In addition, as new antivenoms are available in North America, the response to current treatment is not well reported. The purpose of this study is to provide further insight into the approach to treatment of Crotalus horridus envenomation.
METHODS: This is a retrospective chart
review of 21 cases of presumed envenomation by C. horridus. Data collected included age, sex,
antivenom administration, laboratory data, length of hospital stay, blood products administered, and general clinical course. We also evaluated platelet response to
antivenom, bleeding outcomes, and complications from envenomation.
RESULTS: Patients\' ages ranged from 19 to 71 years. All patients were men. Most patients presented with thrombocytopenia and all had limb swelling. Patients responded initially to antivenom treatment, however subsequently developed a profound thrombocytopenia, including fourteen with platelet counts less than 20 × 109/L. Abnormalities in thromboelastography (TEG) were noted in conjunction with thrombocytopenia. Patients displayed persistent thrombocytopenia despite administration of Crotalidae polyvalent immune Fab or Crotalidae immune F(ab\')2. Median time to rebound platelet count greater than 20 × 109/L was ten days (range 6-12 days) from envenomation. Complications included a partial finger amputation in one patient, bleeding gums in four patients, bloody stools in two patients, bloody nasogastric output in one patient. No patients required red blood cell transfusion and no deaths occurred.
CONCLUSIONS: Practitioners treating C. horridus should recognize the possibility of severe thrombocytopenia and its persistence despite
antivenom. They should counsel patients on appropriate abstention from activities that could lead to trauma, as well as the importance of follow up for repeat laboratory studies to ensure the resolution of thrombocytopenia.