Two weekends ago, as I staffed the ICU satellite, I got a call from a nurse to dispense medicinal leeches for a patient. First, I was taken aback. Having seen leeches in microbiology lab or in the hospitals I interned at, I never have had quite the opportunity to dispense an “order” for leeches as pharmacist.
This patient, having had two hematomas already, was having medicinal leeches used for venous congestion caused by her elective mastectomy surgery.
I mean, it’s not like we haven’t heard of the use of medicinal leeches (Hirudo medicinalis) before. Hirudin, the amino acid protein extracted from the salivary gland of the medicinal leech, is a bivalent thrombin inhibitor (binding to active site and fibrinogen site). What else have we heard of that belong in this class? Why the derivatives and analogues of hirudin- lepirudin, desirudin, bivalirudin. Just this form is not as visually pleasing- who wants to see small worm-like creatures bite on to someone's skin?
Surprisingly, in 2004, a French company called Ricarimpex SAS, applied and was approved by the FDA to use the leech as a medical device in plastic and reconstructive surgery. Figure that.
Don’t get me wrong, there’s the large possibility of infection, most notably, Aeromonas hydrophila infections that can occur around the bite wound of the leech. But the benefit? There's lots, in comparison to heparin at least-no direct effect on platelets, not inactivated by an anti-heparin protein, and so on.
I was definitely not a fan when I saw the little creatures squirming around, as my co-worker dug them out of the jar and put them into the plastic vial. When I went up to the floor to deliver the little creatures to the nurse, she commented to me that she had almost lost a leech. Apparently, one of the the two previous leeches had fallen off the patient (because it was full, of course), and had made its way to the window. The nurse only found it after following its trail of blood. I tried to suppress my look of disgust and surprise.
That day was definitely one of my most memorable days so far in inpatient care. You never know what you might get....