Hemoperfusion as Adjunctive Therapy in Severe Snake Envenomation Refractory to Antivenom: A Case Series

Abstract

Snake envenomation remains a significant cause of morbidity worldwide, with antivenom serving as the cornerstone of treatment. This case series describes outcomes of three male patients (ages 34–63 years) with severe envenomation who demonstrated progressive local swelling and coagulopathy despite receiving at least 15 vials of antivenom. All received adjunctive hemoperfusion using a Nipro HA230 cartridge via femoral venous access (six two‐hour sessions over three days). All patients survived and were discharged after 4–5 days with normalized coagulation parameters and resolved swelling. No hemoperfusion‐related complications were documented. Total antivenom ranged from 15 to 25 vials. These findings suggest hemoperfusion may be a feasible adjunctive therapy in refractory cases, though the observational design precludes definitive conclusions. Hemoperfusion should be considered experimental, reserved for severe refractory cases in well‐resourced settings.