Background/Case Studies: African Bush Viper snakes are found in the rainforest regions of sub-Saharan Africa. A bite from an African Bush Viper can cause severe coagulopathy, pain, edema, renal failure, and rarely, life-threatening hemorrhage. Severe bites require antivenom, but no species-specific antivenoms are readily available in the US.
Study
Design/Methods: A 46-year-old male presented to the emergency center following a bite to the left index finger by an African Bush Viper on 12/10/2023 at approximately 1820.
Results/Findings: Distal left index finger showed soft tissue swelling and discoloration without increased bleeding.Initial labs were ordered while toxicology and poison control consultations were obtained. Inaserp antivenom (South Africa variant) was recommended by poison control if available. At 20:59 PM on 12/10/2023, the hospital transfusion service contacted the primary blood supplier (located 6 hours away) to assist with obtaining the Inaserp antivenom from the local zoo.While transportation logistics were finalized, the patient was monitored with complete blood counts, prothrombin time (PT) with international normalized ratio (INR), partial thromboplastin time (PTT), fibrinogen level, and thromboelastography with lysine (TEG) and provided platelet transfusions when CRTMA levels were below normal and cryoprecipitate transfusions when CFFMA levels were below normal. The anti-venom arrived at the hospital 12/11/2023 at 0715, 10hrs and 16 minutes after contact with the blood center, and the patient received 2 doses of antivenom. Table 1 shows the time sequence of laboratory values, transfusions and antivenom administration. Following the two doses of antivenom, the patient was followed closely. No further transfusions or antivenom were needed and he was discharged on 12/14/2023.Five months after discharge, the patient underwent partial left index finger amputation at the middle phalanx due to continued pain and coldness. Conclusions: This case study represents the successful collaboration between a distant blood collection facility and a hospital in getting antivenom to a patient experiencing hypofibrinogenemia and thrombocytopenia following a bite from an African Bush Viper.
