Clinic
Case reports
Pope 1958, Spies et al. 1962, Lakier and Fritz 1969, Mackay et al. 1969, Matell et al. 1973, Nicolson et al. 1974, Visser and Chapman 1978, Gerber and Adendorf 1980, Geddes and Thomas 1985, Broadley 1960
Signs & symptoms
(Minton 1990b and case reports)
Autopharmacological effects
Nausea, vomiting, diarrhoea.
Local effects
Limited local effect.
Haemostatic effects
Gingival bleeding, epistaxis, haemoptysis, haematuria, bleeding per rectum, melaena, extensive subcutaneous and intracranial bleeding (within hours).
Renal effects
Acute kidney failure (secondary to DIC).
Other symptoms & findings
Headache.
Morbidity
Acute kidney failure (Lakier and Fritz 1969).
Case fatality rate
1/1 Intracranial bleeding (Pope 1958).
Laboratory and physical investigations
1. Haemostasis
Type of haemostatic defect
DIC due to activation of factor X and direct conversion of prothrombin to thrombin (Mackay et al. 1969). Thrombopaenia in the context of DIC. Haemorrhagic effect (Christensen, pers. commun. cited in Nicolson et al. 1974).
| Overview haemostasis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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A
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H | CT | (FSP) | Tc | PT | aPTT | TT | I | FSP | D | II | V | VIII | X | XIII | PC | ATIII | PI | tPA | α2AP | |||||||||||||||||||||||||||||||||||||||||||
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F
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C
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Essential bed-side tests |
Tests for full clinical assessment | Tests for research purposes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| A | CT: increased. |
| B | PT, aPTT: increased. |
| C | Fibrinogen: 0.35 g/l (Geddes and Thomas 1985); 0.1 g/l (Lakier and Fritz 1969). |
| D | TT: increased. |
| E | FSP: ≥1,280 g/ml ≤2,660 g/l (Geddes and Thomas 1985). |
| F | Platelets: minimum 8,000/mm3 (Nicolson et al. 1974); minimum 10,000/mm3 (Lakier and Fritz 1969). |
2. Signs of haemolysis in the context of DIC
(Lakier and Fritz 1969, Nicolson et al. 1974).
3. Haemoglobin
Minimum 7.4 g/100 ml (initial value 18.1 g/100 ml) (Lakier and Fritz 1969).
Minimum 10.8 g/ml (initial value 13 g/ml) (Nicolson et al. 1974).
Treatment (symptomatic)
- Blood transfusion
- Dialysis.
Treatment (specific)
Antivenoms
Boomslang antivenom (SAIMR).
Indications for administration of antivenom
Systemic bleeding.
Confirmation of haemostatic defect with the relevant haemostatic tests (see above).
Dose
20 ml (i.v.) (Geddes and Thomas 1985).
40 ml (i.v.) (Nicolson et al. 1974).
40 ml (i.v.) (Lakier and Fritz 1969).
Efficacy with regard to haemostatic effects
- Clinical:
Systemic bleeding ceased immediately after administration of antivenom (Geddes and Thomas 1985). Systemic bleeding ceased within hours (Nicolson et al. 1974). - Coagulation defect (laboratory investigations):
Normalization of aPTT within 8 h (Geddes and Thomas 1985). Normalization of clotting time, TT and fibrinogen within hours (Nicolson et al. 1974). Normalization of coagulation tests within 72 h (Lakier and Fritz 1969). - Thrombopaenia (laboratory investigations):
Increase in platelets within hours, normalization within 5 days (Nicolson et al. 1974). Increase in platelets within 24 h, normalization within 7 days (Lakier and Fritz 1969).
Adverse reactions
Immediate hypersensitivity (Nicolson et al. 1974, Lakier and Fritz 1969).
Pyrogenic reaction (Geddes and Thomas 1985).
Serum sickness (Nicolson et al. 1974).
Evaluation and recommendations
According to these few case reports, the specific antivenom appears to be effective with regard to the haemostatic defect (in particular the coagulation defect).