TY - JOUR
T1 - Schistocyte quantitation, thrombotic microangiopathy and acute kidney injury in Australian snakebite coagulopathy [ASP28]
AU - Noutsos, Tina
AU - Currie, Bart J.
AU - Brown, Simon G.
AU - Isbister, Geoffrey K.
N1 - Funding Information:
T. Noutsos was financially supported by a University Postgraduate Research Scholarship and Menzies School of Health Research support funds; GK Isbister is supported by an NHMRC Senior Research Fellowship 1061041. The Australian Snakebite Project is funded by an NHMRC Clinical Centre for Research Excellence 1110343. The funders played no role in the study design; collection, analysis or interpretation of data; writing of the report; or in the decision to submit the paper for publication.
PY - 2021/10
Y1 - 2021/10
N2 - Introduction: The major systemic manifestation of hemotoxicity in human snakebite envenoming is venom-induced consumption coagulopathy (VICC). A subset of patients with VICC develop thrombotic microangiopathy (TMA), in which acute kidney injury (AKI) occurs. We aimed to investigate the association between schistocytosis in snakebite patients with VICC and AKI, compared to non-envenomed patients. Methods: Serial blood films collected from a prospective cohort of snakebite patients (Australian Snakebite Project) were examined. Cases were classified a priori as non-envenomed snakebites (normal controls), envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI based on defined clinical and laboratory criteria. The percentage of schistocytes between groups was compared and correlated by Kendall's tau b test. Results: Seven hundred and eighty blood films from 234 snakebite cases were analyzed. There was a statistically significant correlation (τ =.69, SE.03, P <.001) for schistocytosis between the ordered groups of non-envenomed snakebites, envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI groups. Patients with VICC and AKI had a platelet nadir median of 42 × 109/L (interquartile range [IQR] :25-130 × 109/L), hemoglobin nadir of median 107 g/L (IQR 66-122 g/L), and maximum LDH median of 1128 U/L (IQR 474-3255 U/L). A 1.0% threshold for schistocytosis yielded 90% sensitivity (95% CI: 67%-98%) and 71% specificity (95% CI: 62%-79%) for predicting AKI in patients with VICC. Conclusion: Schistocyte quantitation has good diagnostic utility in snakebite patients with VICC. A definition of snakebite TMA as MAHA with ≥1.0% schistocytes and thrombocytopenia, would appear to be appropriate.
AB - Introduction: The major systemic manifestation of hemotoxicity in human snakebite envenoming is venom-induced consumption coagulopathy (VICC). A subset of patients with VICC develop thrombotic microangiopathy (TMA), in which acute kidney injury (AKI) occurs. We aimed to investigate the association between schistocytosis in snakebite patients with VICC and AKI, compared to non-envenomed patients. Methods: Serial blood films collected from a prospective cohort of snakebite patients (Australian Snakebite Project) were examined. Cases were classified a priori as non-envenomed snakebites (normal controls), envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI based on defined clinical and laboratory criteria. The percentage of schistocytes between groups was compared and correlated by Kendall's tau b test. Results: Seven hundred and eighty blood films from 234 snakebite cases were analyzed. There was a statistically significant correlation (τ =.69, SE.03, P <.001) for schistocytosis between the ordered groups of non-envenomed snakebites, envenomed without VICC, partial VICC without AKI, complete VICC without AKI, and VICC with AKI groups. Patients with VICC and AKI had a platelet nadir median of 42 × 109/L (interquartile range [IQR] :25-130 × 109/L), hemoglobin nadir of median 107 g/L (IQR 66-122 g/L), and maximum LDH median of 1128 U/L (IQR 474-3255 U/L). A 1.0% threshold for schistocytosis yielded 90% sensitivity (95% CI: 67%-98%) and 71% specificity (95% CI: 62%-79%) for predicting AKI in patients with VICC. Conclusion: Schistocyte quantitation has good diagnostic utility in snakebite patients with VICC. A definition of snakebite TMA as MAHA with ≥1.0% schistocytes and thrombocytopenia, would appear to be appropriate.
KW - acute kidney injury
KW - hemolysis
KW - schistocytes
KW - snakes
KW - thrombotic microangiopathies
UR - http://www.scopus.com/inward/record.url?scp=85101140215&partnerID=8YFLogxK
U2 - 10.1111/ijlh.13497
DO - 10.1111/ijlh.13497
M3 - Article
C2 - 33615713
AN - SCOPUS:85101140215
VL - 43
SP - 959
EP - 965
JO - International Journal of Laboratory Hematology
JF - International Journal of Laboratory Hematology
SN - 1751-5521
IS - 5
ER -