Please answer BOTH questions 6 and 7 completely. There are many examples of both

Question

Please answer BOTH questions 6 and 7 completely.

There are many examples of both vertebrates and invertebrates that use toxins to subdue and predigest their prey. Many of these toxins are neurotoxins that influence both the central nervous system and affect the function of the neuromuscular junction to cause paralysis. Many venoms are hemo- or cytotoxic causing bleeding, clotting or necrosis of tissues. The following medical case is a real story of a Canadian woman returning from a trip to Peru.

A 22-year-old woman who was previously healthy presented with a 4-day history of expanding ecchymoses. She had no other bleeding manifestations and denied any other symptoms such as muscle or joint pain, rashes, and had undergone no physical trauma. Her medical history
was unremarkable. She was not taking any medication, and she had no family history of bleeding problems or hematologic disorders. Her last normal menstrual period was 2 weeks before admission. The patient had no fever or inflammation of the lymph nodes, normal vital signs, and results of her cardiovascular, respiratory and abdominal examinations were normal.

Seven days before admission the patient had returned from northeastern Peru, where she had stepped barefoot on 5 caterpillars. Immediately after contact with the caterpillars, she experienced burning pain in her foot, radiating proximally to her thigh. The pain worsened when she walked. A headache also developed. Both the foot pain and headache resolved over the subsequent 12 hours and she did not seek medical care at that time. Initial laboratory tests are summarized in Table 1 below.

We diagnosed an atypical presentation of disseminated intravascular coagulation or primary fibrinolysis triggered by an unknown process. We started treatment with fresh frozen plasma, cryoprecipitate and fibrinogen concentrate. In view of her presenting signs and symptoms and travel history, we searched MEDLINE and Google Scholar, which revealed the possibility of caterpillar envenomation that could account for all her clinical symptoms and laboratory results.

6. How might the administration of fibrinogen concentrate reduce the amount of uncontrolled bleeding in this patient?

Although our local poison control center had no knowledge of caterpillar envenomation, they facilitated contact with clinicians from Brazil, who recommended immediate administration of a locally produced antivenin. We made arrangements to obtain the antivenin from Brazil, which took 48 hours to arrive.

7. What class of macromolecule is antivenin?

Table 1: Results of initial laboratory tests performed for a 22-year-old woman who presented with a 4-day history of expanding ecchymoses Result (reference range) 125 (120-160) 216 (140-450) 7.9 (4.0-11.0) 610 (650-1900) 16 (

Explanation / Answer

6.Generally fibrinogen is a plasma glycoprotein.Fibrinogen includes platelet activation and aggregation by binding to the platelet fibrinogen receptor glycoprotein GPIIb/IIIa.

Fibrinogen concentrate is generally produced from pooled human plasma using the Cohn/ Oncley cryoprecipitation procedure.

It is considered as the mainstay of treatment of bleeding episodes in patients with congential afibrinogenaemia.So, administration of fibrinogen concentrate reduce the amount of ucontrolled bleeding due to its anticoagulant nature.

7.Antivenin is an antitoxin that conteracts the effects of venom from a bite of poisonous creatures like snakes, some insects or other poisonous animals.It is considered biological product used in venomous bites.It is an antiserum which contains antitoxins and helo in removal of poison.

Antivenin is a class of macromolecule in which small molecule drug class is discovered using a target centered approach.

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