BACK of the BOOK patients with advanced-stage snake bites came to us with a swollen , bleeding hand and needed platelet transfusions and plasma , it was a huge challenge .
When did you recognize a connection between herpetology and hematology ? While I was caring for patients , I saw that many complications associated with snake bites – particularly from vipers and kraits – were hematologic . Bite victims would develop bleeding and clotting syndromes , including disseminated intravascular coagulation ( DIC ).
I realized that I needed to better understand how snake venoms affected the endothelium and coagulation cascade . After my year of service , I returned to Mumbai for an internal medicine residency at the Grant Medical College and Sir J . J . Hospital . The more I encountered patients with advanced snake bites in the intensive care unit , the more my fascination with venoms grew .
I began studying snakes and their venoms and uncovered the tremendous impact that they have on medicine in general and hematology in particular . Many hematologic lab tests are based on snake venoms as are many drugs in development originate from them . This compelled me to further study the mambas , taipans , and bushmasters in Australia and Africa and the rattlers and corals in America .
The way their venoms are designed to physiologically damage intricate animal systems is extraordinary . Pit vipers , for example , use sonar technology to size up their prey and decide how much venom they need . There ’ s so much to learn !
What is the connection between hematology and herpetology ? There are multiple tests to assess the integrity of the coagulation cascade that rely on snake venoms , including the dilute Russell ’ s viper venom time , the Protac assay for protein c , the Taipan venom time , the ecarin time , the reptilase time , and more . None of these tests would exist without snake venoms .
Venomous snakes are one of two animals that have contributed to the development of systemic anticoagulants ; the defibrinogenating agent ancrod , for instance , is derived from the venom of the Malayan pit viper . Snake venom , obviously , is also required to produce anti-venom . Snakes are “ milked ” through their fangs and their venom is injected into horses or other large animals , from which antibodies in the plasma are taken three weeks later .
In countries like India and Sri Lanka , where these snakes are indigenous , catching them is actually an occupation . Luckily , I never had to do this ; I left that to the specially trained , extremely cautious professionals !
How did your experiences in the rural clinic affect your career path ? I was planning to specialize in coagulation , thrombosis , and hemostasis , and then focus more on DIC and consequences of venoms , but life takes you down different roads , and I became interested in myeloid malignancies , especially myelodysplastic syndromes and chronic myelomonocytic leukemia . But I credit my entry into hematology indirectly to herpetology . I don ’ t think I would have been a hematologist today had it not been for my exposure to snakes and snake venoms .
“ I don ’ t think I would have been a hematologist today had it not been for my exposure to snakes and snake venoms .”
When I came to the U . S . to pursue further training in hematology , I did an internal medicine residency at the University of Minnesota with Nigel Key , MBChB , who was an expert in coagulation . Then I came to Mayo Clinic , also in Minnesota , for my fellowship – a state with no venomous snakes ! There have been a few timber rattlesnake sightings , but very little to quench my thirst for snake bites and coagulation .
Every now and then , I get phone calls from clinicians who need advice on managing snake-bite – related syndromes . About four years ago , I received a call at 8 p . m . from a clinician in the emergency department of a hospital in Duluth , Minnesota , because he had a patient who was bitten by his pet Egyptian cobra . That ’ s the last thing you expect to happen in Duluth , so they had no experience in treating a cobra bite . I walked them through managing neurotoxic snake bites and connected them to the Centers for Disease Control and Prevention to get more help .
How did your reputation as an expert in herpehematology spread ? There was a global health course at the University of Minnesota , in which professors from around the world taught topics like clinical topical medicine , infectious diseases , or humanitarian aid during medical emergencies . When my professors learned how passionate I was about snakes and how much experience I had in this area , I was asked to teach in the global health course about snakes , scorpions , and other insects and reptiles that were relevant to hematology . Soon after that , I was invited to speak at the emergency room physician meetings . Dr . Key , who was still at the University of Minnesota then , invited me to speak at the coagulation forums , and my reputation spread by word of mouth from there .
I ’ ve also done a number of presentations around the U . S . about how the study of snake venoms has contributed to hematology and how snake venoms can be used to understand biology .
Have you ever been bitten by a venomous snake ? Fortunately , no – though not because I didn ’ t have the chance ! I learned a few lessons in how to avoid snake bites from my experiences in India . Even if a snake is dead or decapitated , it can still bite for up to two hours because of preserved monosynaptic
— MRINAL PATNAIK , MBBS
reflexes . Many times , patients were taught to kill the snake that had bitten them and bring it in for identification so we could administer the appropriate anti-venom , but we saw plenty of people bitten by “ dead ” snakes . So , always steer clear !
Do snakes scare you ? No , not at all . You have to be careful , but most snakes don ’ t attack unless someone stumbles into their environment . It ’ s a side effect of what urbanization is doing to their habitats . Except for mambas and bushmasters , there are few snakes that are predatory to humans .
Snakes are usually shy . Most of the immediate bites are “ dry ” bites – serving more as a warning because they are afraid and trying to escape . If you ’ re in Africa , though , the green and black mambas will come after you .
The more common snake-bite scenario in the U . S . is an accidental bite from an exotic pet snake , or someone who ’ s drunk and thinks it ’ s a good idea to pick up a rattlesnake .
Do you keep snakes as pets ? My interest hasn ’ t extended to that yet . I do enjoy learning about them and visiting the snake exhibits at local zoos when I travel . My favorite was last year , when I was invited to speak at the Highlights of ASH ® in Asia – Pacific in Brisbane , Australia . One of the first things I did was visit the Australia Zoo to look at the taipans , which are the most venomous snakes in the Outback . ●
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