Microangiopathic Hemolytic Anemia Following Three Different Species of Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

Rathnayaka Mudiyanselage M K Namal Rathnayaka; Anusha Nishanthi Ranathunga; Senanayake A M Kularatne; Jayanthe Rajapakse; Shirani Ranasinghe; Radha Jayathunga

doi:10.1016/j.wem.2017.11.003

Microangiopathic Hemolytic Anemia Following Three Different Species of Hump-Nosed Pit Viper (Genus: Hypnale) Envenoming in Sri Lanka

Wilderness Environ Med. 2018 Mar;29(1):94-101. doi: 10.1016/j.wem.2017.11.003. Epub 2018 Feb 1.

Authors

Rathnayaka Mudiyanselage M K Namal Rathnayaka¹, Anusha Nishanthi Ranathunga², Senanayake A M Kularatne³, Jayanthe Rajapakse⁴, Shirani Ranasinghe³, Radha Jayathunga⁵

Affiliations

¹ Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka (Drs Rathnayaka and Rajapakse); Intensive Care Unit/Anaesthesia, Provincial General Hospital, Ratnapura, Sri Lanka (Dr Rathnayaka). Electronic address: [email protected].
² Medical Unit, Provincial General Hospital, Ratnapura, Sri Lanka (Dr Ranathunga).
³ Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka (Drs Kularatne and Ranasinghe).
⁴ Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka (Drs Rathnayaka and Rajapakse).
⁵ Medical Unit, Provincial General Hospital, Ratnapura, Sri Lanka (Dr Ranathunga); Haematology Unit, Provincial General Hospital, Ratnapura, Sri Lanka (Dr Jayathunga).

PMID: 29361387
DOI: 10.1016/j.wem.2017.11.003

Abstract

There are 3 species of hump-nosed pit vipers in Sri Lanka: Hypnale hypnale, Hypnale zara, and Hypnale nepa. The latter 2 are endemic to the country. Microangiopathic hemolytic anemia (MAHA) is a known complication of hump-nosed pit viper bites. It was previously documented as a complication of general viper bites and not species specific. We report a series of 3 patients who developed MAHA after being bitten by each species of hump-nosed pit viper. The first patient was bitten by H hypnale and developed a severe form of MAHA associated with acute kidney injury and thrombocytopenia falling into the category of thrombotic microangiopathy. The other 2 developed MAHA that resolved without any complications.

Keywords: Hypnale hypnale; Hypnale nepa; Hypnale zara; snakebites.

Publication types

Case Reports

MeSH terms

Acute Kidney Injury / diagnosis*
Acute Kidney Injury / etiology
Aged
Anemia, Hemolytic / complications
Anemia, Hemolytic / diagnosis*
Animals
Crotalinae*
Humans
Male
Middle Aged
Snake Bites / complications*
Species Specificity
Sri Lanka