Circulating microvesicles in snakebite patients with microangiopathy
Author(s): ,
Anoop K. Enjeti
Affiliations:
Department of Haematology, Calvary Mater Newcastle, Waratah, Australia. School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. NSW Health Pathology–Hunter, Newcastle, Australia. Hunter Medical Research Institute, New Lambton, Australia. Hunter Cancer Research Alliance, Newcastle, Australia
Correspondence |Dr. Anoop K Enjeti, Department of Haematology, Level 4 New Med Building, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia.|Email: anoop.enjeti@calvarymater.org.au
,
Lisa F. Lincz
Affiliations:
Department of Haematology, Calvary Mater Newcastle, Waratah, Australia. Hunter Medical Research Institute, New Lambton, Australia. Hunter Cancer Research Alliance, Newcastle, Australia. School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
,
Michael Seldon
Affiliations:
Department of Haematology, Calvary Mater Newcastle, Waratah, Australia. School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. NSW Health Pathology–Hunter, Newcastle, Australia
Geoffrey K. Isbister
Affiliations:
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. Hunter Medical Research Institute, New Lambton, Australia
ISTH Academy. Enjeti A. Jan 15, 2019; 273421
Assoc. Prof. Anoop Enjeti
Assoc. Prof. Anoop Enjeti
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Journal Abstract
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Background
Venom‐induced consumption coagulopathy is a common consequence of snake envenoming that can lead to life‐threatening hemorrhage, and is associated with microangiopathic hemolytic anemia (MAHA), acute kidney injury and thrombocytopenia. The role of microvesicles (MV) in snakebite patients has not been previously investigated.
Objective
To compare changes in subsets of circulating MV levels in snakebite patients with venom induced consumption coagulopathy and with or without microangiopathic hemolysis to those of healthy controls.
Methods
This study used samples from patients recruited to the Australian Snakebite Project (ASP) with snake envenoming, including bites by brown snakes, tiger snakes, and taipans. Citrated blood from envenomed patients was collected, processed, and stored according to a national standardized protocol. Full blood count and coagulation parameters were measured as per routine clinical care and blood films were examined for evidence of hemolysis. Baseline coagulation parameters were measured on a Behring Coagulation System. Flow cytometry was performed to detect CD41a (platelet), CD62e (endothelial), and glycophorin (red cell) MV. The results were analyzed using BD software and appropriate statistical tools.
Results and Conclusions
The red cell MV in snakebite patients with MAHA (n = 13) were significantly higher than those without MAHA (n = 17) while there was no significant difference in platelet MV levels between the snakebite patients with and without MAHA. Interestingly, the endothelial MV were reduced in all snakebite patient samples compared to the control samples. Measuring red cell MV at presentation could be useful as a predictive marker for MAHA in patients with snakebites.
Keyword(s)
coagulopathy, extracellular vesicles, microangiopathy, microvesicles, snakebite, venom
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