e Russell's viper holds high clinical significance as a fatal venomous snake with its venom including predominantly hemotoxic effects as well as nephrotoxic, neurotoxic, and myotoxic effects.A 24-year-old woman presented following accidental exposure to Russell's viper venom while handling the snake for research purposes.She developed vomiting and dark-colored urine within 1-2 h.On examination, she had partial ptosis but was hemodynamically stable.Laboratory investigations revealed mild anemia with a hemoglobin level of 10.8 g/dL and marked thrombocytopenia with a platelet count of 19 10/L.e peripheral blood smear showed normochromic, normocytic red blood cells with fragmented forms (schistocytes), Figure 1 consistent with microangiopathic hemolytic anemia (MAHA).Her whole blood clotting time was prolonged, and coagulation studies demonstrated a prolonged prothrombin time of 20.2 s, an activated partial thromboplastin time of 32.5 s, and a low serum fibrinogen level of 1.2 g/L.Indirect hyperbilirubinemia was also noted.Due to a documented history of an anaphylactic reaction to antivenom, plasma exchange therapy was initiated as an alternative treatment strategy.Following a single cycle of plasma exchange, her platelet count improved to 42 10/L and subsequently normalized to 158 10/L.A repeat blood smear demonstrated a marked reduction in red blood cell fragmentation.
Andradi et al. (Thu,) studied this question.