An Unusual Presentation of Vasculotoxic Snake Bite.

In India, viper bites are more common than any other poisonous snake bites. In these patients, the cardinal features are local pain, swelling and mild coagulation abnormalities; but gangrenous changes involving bilateral upper and lower limbs are uncommon. We are reporting a case of a 62-year-old man bitten by a Russell viper on the right thumb. He experienced local pain, swelling and later developed disseminated intravascular coagulopathy, pre-renal azotemia, sepsis, acute respiratory distress syndrome (ARDS) and peripheral gangrenous changes involving bilateral upper and lower limbs. He succumbed to his ailment 5 months after the bite. There have been very few cases of gangrenous changes involving distal part of extremities associated with snake bite.

Whole blood clotting time: Variation of practice in coagulation laboratory, members of Thailand national external quality assessment scheme.

Objective: To collect the necessary data for a perspective of Whole Blood Clotting Time (WBCT) practice in Thailand. Methods: In March 2007, 124 questionnaires were sent to laboratory members of the Thailand National External Quality Assessment Scheme (Thailand NEQAS) to obtain essential information about the WBCT practice. Results: From a dispatch of 124 questionnaires, 120 (96.77%) were returned. There were 101 (84.1%) hospitals performing WBCT in the laboratories and the mean number of WBCTs performed was 16.17 times/month. Eighty nine laboratories (88.11%) used the modified Lee-White methods. Seventy four laboratories (73.26%) used snake bite and other animal bites as the indication for WBCT. Thirty three laboratories (34.37%) had problems performing the WBCT. Conclusion: The WBCT methods among the practice of the Thailand NEQAS laboratory members were as various as problems concerning WBCT throughout Thailand. Their practice needs to be improved and standardized by proper education. It also emphasizes the need for an appropriate guidelines for WBCT in Thailand.