The Role of Plasmapheresis in Snake Envenoming: a Systematic Review

Background Envenoming from numerous sources, such as snakes, scorpions, and spiders, is a major health issue across the world, resulting in millions of cases and tens of thousands of deaths annually. Venom induced symptoms ranges from systemic reactions like nausea and vomiting to localised pain and swelling. One major risk is the development of venom induced consumption coagulopathy (VICC), which might result in significant consequences. Plasmapheresis is being investigated as a possible therapy for severe envenoming. Objectives We aim to assess the effectiveness and potential advantages of plasmapheresis in snakebite cases, focusing on clinical results. We seek to find if plasmapheresis improves neurological, renal, and hematological dysfunction and impacts secondary outcomes, including patient discharge rates, morbidity, mortality, duration of hospital stay, and the number of plasmapheresis sessions required. Methods Following PRISMA guidelines, we conducted a systematic search of articles published between 1980 and July 2023 across multiple databases. MeSH terms related to snakebite and plasmapheresis were applied without publication or language type restrictions. Inclusion criteria considered case reports, cross-sectional studies, or case series featuring plasmapheresis in snakebite management. Inclusions were participants aged 18 years or older with confirmed or suspected snakebites, meeting plasmapheresis indications. Exclusions included participants under 18 years, studies reporting only in vitro data, review articles, and redundant reporting. The emphasis was on Emergency Departments or Intensive Care Units. Results In a review of 147 cases (1980 to July 2023), the most common snake was the hump-nosed viper (Hypnale hypnale). Renal, neurological, and hematological dysfunctions improved after plasmapheresis. The mean plasmapheresis sessions were 2.1, and the average hospital stay was 13.13 days. Conclusion Once the data has been analyzed, the result emphasizes the clinical importance of plasmapheresis in snakebite envenoming. It helps decision-making when standard therapies are insufficient or ineffective, potentially saving lives. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: PROSPERO (ID: CRD42023459261) was used to register the study protocol I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All data underlying are provided in attachments as supporting information without restriction