The role of plasmapheresis in snake envenoming: a systematic review
Authors: Prasad Hari , Kaeley Nidhi , Jose Jewel Rani , U N Ajun , Shankar Takshak , Salam Ajmal , Shukla Krishna 
Published: September 2024

Background

Envenoming from numerous sources, such as snakes, scorpions, and spiders, is a major health issue across the world, resulting in millions of cases and tens of thousands of deaths annually. Venom induced symptoms ranges from systemic reactions like nausea and vomiting to localised pain and swelling. One major risk is the development of venom induced consumption coagulopathy (VICC), which might result in significant consequences. Plasmapheresis is being investigated as a possible therapy for severe envenoming.

Objectives

We aim to assess the effectiveness and potential advantages of plasmapheresis in snakebite cases, focusing on clinical results. We seek to find if plasmapheresis improves neurological, renal, and hematological dysfunction and impacts secondary outcomes, including patient discharge rates, morbidity, mortality, duration of hospital stay, and the number of plasmapheresis sessions required.

Methods

Following PRISMA guidelines, we conducted a systematic search of articles published between 1980 and July 2023 across multiple databases. MeSH terms related to snakebite and plasmapheresis were applied without publication or language type restrictions. Inclusion criteria considered case reports, cross-sectional studies, or case series featuring plasmapheresis in snakebite management. Inclusions were participants aged 18 years or older with confirmed or suspected snakebites, meeting plasmapheresis indications. Exclusions included participants under 18 years, studies reporting only in vitro data, review articles, and redundant reporting. The emphasis was on Emergency Departments or Intensive Care Units.

Results

In a review of 147 cases (1980 to July 2023), the most common snake was the hump-nosed viper (Hypnale hypnale). Renal, neurological, and hematological dysfunctions improved after plasmapheresis. The mean plasmapheresis sessions were 2.1, and the average hospital stay was 13.13 days.

Conclusion

Once the data has been analyzed, the result emphasizes the clinical importance of plasmapheresis in snakebite envenoming. It helps decision-making when standard therapies are insufficient or ineffective, potentially saving lives.

Author Summary

Snakebites pose a significant global health threat, causing numerous deaths and serious injuries annually. While antivenom is the primary treatment, it’s not always effective or available. This study explores an alternative treatment called plasmapheresis, a method that filters harmful substances from the blood.

We reviewed 147 cases of snake envenoming treated with plasmapheresis between 1980 and 2023. Our findings show that plasmapheresis can improve various complications caused by snake venom, including kidney problems, nerve damage, and blood disorders. On average, patients received about two plasmapheresis treatments and stayed in the hospital for around 13 days.

The study suggests that plasmapheresis could be a valuable option when standard treatments aren’t working well enough. It might help save lives in severe cases of snake envenoming. While more research is needed, this review provides important insights for doctors treating snakebite victims, especially in areas where snakebites are common and resources are limited.