518 Tropical Biomedicine 28(3): 518–523 (2011) A novel management method for disseminated intravascular coagulation like syndrome after a sting of Hemiscorpius lepturus: A case series Ali A Shayesteh 1 , Nima Zamiri 2 , Payam Peymani 2 , Farzad Jassemi Zargani 3 and Kamran B Lankarani 2* ¹Ahvaz University of Medical Sciences, Ahvaz, Iran ²Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 3 Imam Khomeini Hospital, Gastroenterology Ward, Ahvaz, Iran * Corresponding author email: lankaran@sums.ac.ir Received 4 December 2010; received in revised form 17 April 2011; accepted 29 April 2011 Abstract. In this case series report we aim to report a Disseminated Intravascular Coagulation (DIC)-like syndrome associated with Hemiscorpius lepturus sting in 4 individuals and a novel management protocol for this life-threatening condition that comprised partial exchange transfusion in severe scorpionism. INTRODUCTION Scorpion sting is considered to be an important public health problem in Khuzestan province, in southwest of Iran. Hemiscorpius lepturus (Hemiscorpiidae) occurs along the Iranian border, especially adjacent to Khuzestan in the south-west where it is responsible for 67% of scorpion sting fatalities (Radmanesh, 1990a). This type of scorpion which is an inhabitant of this part of Iran, especially in northern parts of the province is the most lethal scorpion in Iran (Radmanesh, 1990b). Although most victims develop local symptoms after being stung such as pain and swelling, approximately 30% of them further develop systemic symptoms as hyperthermia, sweating, flushing, vomiting, restlessness, neurological symptoms and hematological disturbances (Radmanesh 1990a, Pipelzadeh et al., 2007). In more severe cases neurological symptoms are predominant (Radmanesh, 1990b, 1998). Intravascular hemolysis is one of the most common hematological complications after being stung by H. lepturus and in more severe forms; the victims develop hemoglobinuria (Pipelzadeh et al ., 2007). Some of them develop coagulation disorders leading to prolongation of Prothrombine Time (PT), Partial Thromboplastine Time (PTT) and bleeding diathesis (Pipelzadeh et al., 2007) & Disseminated Intravascular Coagulation (DIC) (Afzali & Pezeshki, 1998). Despite Antivenome injection & transfusion of blood products such as packed Red Blood Cells (RBCs) & Fresh Frozen Plasma FFP, patients’ conditions deteriorate. They develop bleeding at venipuncture sites, cutaneous ecchymosis & then pulmonary, gastrointestinal and Central Nervous System (CNS) hemorrhage. These symptoms are followed by respiratory failure and vasopressor-unresponsive hemodynamic instability leading to death. The scenario begins clinically with paroxysms of intravascular hemolysis and dark color urine consequently leading to a clinical syndrome resembling DIC. At present there is no established effective management for this severe DIC-like syndrome and all other supportive modalities don’t change the outcome (Afzali & Pezeshki, 1998, Pipelzadeh et al., 2007). However, prolonged Activated Partial thromboplastine time (APTT) was associated with moderate to severe form of