{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:34:58Z","timestamp":1790728498220,"version":"4.1.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> \u2014Thrombotic microangiopathy (TMA), which is the triad of acute kidney injury (AKI), microangiopathic hemolytic anemia (MAHA), and thrombocytopenia, is a rare complication of snakebites, and in Sri Lanka, it is commonly seen with hump-nosed pit viper (HNPV) bites. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> \u2014We conducted a prospective observational study of patients with AKI caused by HNPV bites in Teaching Hospital, Ratnapura, Sri Lanka for 6 y, commencing in June 2015. Some patients with TMA underwent therapeutic plasma exchange (TPE) and some did not. These 2 groups were compared. Statistical analysis was carried out using Minitab 18.1. Data were presented as median (IQR). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> \u2014There were 52 (8%) patients with TMA, of whom 21 (45%) were in the TPE group and 26\u00a0(55%) were in the non-TPE group. TPE improved time to platelet correction (4 d [IQR, 4\u20135 d] vs 7 d [IQR, 5\u20139 d]; P=0.009), time to MAHA correction (5 d [IQR, 3\u20134 d] vs 7 d [IQR, 6\u20139 d]; P=0.004), time to prothrombin time (PT)\/international normalized ratio (INR) correction (1 d [IQR, 1\u20132 d] vs 3 d [IQR, 3\u20134 d]; P=0.003), and time to 20 min whole blood clotting test (WBCT20) correction (2 d [IQR, 1\u20132 d] vs 3 d [1QR 2\u20133 d]; P=0.020). Renal recovery was predicted by TPE ( P=0.048) and highest creatinine level ( P=0.001). There was no association between TPE and dialysis dependency at discharge ( P=0.597), length of hospital stay ( P=0.220), and the number of dialysis cycles prior to discharge ( P=0.540). TPE did not improve the number of blood transfusions (5 packs [IQR, 3\u20138.5 packs] vs 4 packs [IQR, 0\u20139 packs]; P=0.290). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> \u2014TPE is effective for TMA in the early correction of platelet counts, MAHA, PT\/INR, and WBCT20 in HNPV bites. <\/jats:p><\/jats:sec>","DOI":"10.1016\/j.wem.2022.07.012","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T16:09:52Z","timestamp":1665677392000},"page":"386-398","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Therapeutic Plasma Exchange for Venom-Induced Thrombotic Microangiopathy Following Hump-Nosed Pit Viper (Genus: <i>Hypnale<\/i>) Bites: A Prospective Observational Study"],"prefix":"10.1177","volume":"33","author":[{"given":"R.M.M.K. 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