Severe puff adder (Bitis arietans) envenomation with coagulopathy

BACKGROUND: The puff adder (Bitis arietans) is a highly toxic venomous snake that is responsible for a large proportion of the venomous snakebites in sub-Saharan Africa, where it is indigenous. Puff adder bites in North America result from snakes in captivity. Although thrombolytic enzymes are present in puff adder venom, significant coagulopathy has not been previously reported with a confirmed puff adder envenomation. RESULTS: We report a serious puff adder envenomation to the finger, characterized by severe swelling, local tissue necrosis, hypotension, thrombocytopenia, severe coagulopathy, and hemorrhage. Fifteen vials of South Africa polyvalent antivenom were administered, beginning 4.5 hours post-envenomation, with step-wise improvement in hematological abnormalities. Other treatments included vasopressors, ventilatory support, leeches, transfusion, and eventual digit amputation. After a prolonged hospital course, the patient had a good outcome. CONCLUSIONS: Puff adder envenomation causes tissue necrosis, hypotension, coagulopathy, thrombocytopenia, and spontaneous bleeding. Severe coagulopathy may occur. Physicians treating severe cases should be prepared to administer at least 15 vials of antivenom if needed.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Serious puff adder envenomation case with tissue necrosis, hypotension, thrombocytopenia, severe coagulopathy and hemorrhage; treatment included 15 vials antivenom, vasopressors, ventilation, leeches, transfusion, and digit amputation.

Erfahren Sie, wie diese Forschung mit der klinischen Praxis verknüpft ist

More peer-reviewed studies in Klinische Studien.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Efficacy and Safety of Hirudotherapy for Improving Sperm Quality Parameters in Male Infertility: A Randomized Controlled Trial — Abtahi-Forooshani M et al. (2026)
• Reverse Sural Flap Venous Congestion Successfully Managed With Enoxaparin in a Male Patient With a Traumatic Foot Crush Injury: A Case Report — Velasco-Bustamante J et al. (2026)
• Investigation of the therapeutic effects of medicinal leech treatment on lower extremity ischemia-reperfusion injury — Ünal K et al. (2026)
• Efficacy of Medicinal Leech Therapy in Diverse Clinical Applications: A Comprehensive Study from Azerbaijan — Farzali S et al. (2025)
• HIRUDOTHERAPY IN RECONSTRUCTIVE SURGERY: CASE-REPORTS AND REVIEW — Heinz P et al. (2020)
• Hirudotherapy Efficacy and Complications in the Management of Microsurgical Breast Reconstruction: A Systematic Review — Foppiani J et al. (2024)
• Hirudotherapy in Wound Healing — Nair H et al. (2022)

Browse all ASH-analysed research →