Assessment of clinical parameters among patients with snake poison induced coagulopathy

Background: Snakes are poikilothermic carnivorous reptiles that have evolved the venomous apparatus for the purpose of procurement of food. Snake bite can result in local and systemic complications. Major systemic complications include acute renal failure, neurologic abnormalities requiring ventilator support and disseminated intravascular coagulation. Disseminated intravascular coagulation can result in serious life-threatening systemic complications like haemorrhage, infarction and even death if the treatment is delayed. The present study was undertaken to study the clinical profile of the snake bite patients who develop coagulopathy and to study the role of coagulation markers to evaluate the morbidity and mortality of snake bite victims.Methods: Hundred patients consecutively admitted with history of snakebite were studied. Patients who have developed local signs of envenomation due to snake bite were included in the study group. The coagulation profile was assessed by doing blood investigations.Results: In this study, patients who developed coagulopathy had prolonged hospital stay and requirement of more blood products transfusion causing increased morbidity. 43 patients (35.8%) had platelets less than 1 lakh and approximately hospitalized for 26 days sand INR was more than 1.5 in 112 patients (93.3%) and hospitalized for 22 days and they received fresh frozen plasma. The survival rate in this study was 86% followed by 13.3% deaths.Conclusions: Use of clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper evenomation

The whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients. Methods In order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin. Results WBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30)...

Delayed double reading of whole blood clotting test (WBCT) results at 20 and 30 minutes enhances diagnosis and treatment of viper evenomation

The whole blood clotting test (WBCT) is a simple test of coagulation that is often used in the assessment, diagnosis, and therapeutic monitoring of snakebite patients in sub-Saharan Africa. WBCT requires only a clean glass tube and several milliliters of venous blood and is ideal for use in poorly equipped health centers throughout the rural areas where 95% of snakebites occur. However, questions surrounding the accuracy and reliability of the test remain unanswered due to variations in testing conditions and a lack of comparative research with which to validate them. This is the first study to evaluate WBCT results at both 20-min (WBCT20) and 30-min (WBCT30) reading times in the same group of snakebite patients. Methods In order to define the best reading time, the authors compared the results of serial WBCT evaluation at both 20 and 30 min after collection in 23 patients treated for snake envenomation in Bembèrèkè, northern Benin. Results WBCT results were identical at both reading times in patients without coagulopathy or when coagulation was restored permanently following a single dose of antivenom. Out of 17 patients with coagulopathy, 14 showed discrepancies between WBCT20 and WBCT30 results in at least one pair of serial evaluations. These could be completely contradictory results (e.g. normal clot at WBCT20 and no clot at WBCT30) or a marked difference in the quality of the clot (e.g. no clotting activity at WBCT20 and an unstable partial clot at WBCT30). WBCT discrepancies were encountered most frequently in three situations: initial normalization of hemostasis following antivenom therapy, detection of a secondary resumption of coagulopathy, or final restoration of hemostasis after a secondary resumption had occurred. Conclusions This study suggests that the WBCT is robust and that a sequential reading should improve the diagnosis and monitoring of venom-induced coagulopathies. It also indicates the possibility of discrepancies in the sensitivity of WBCT20 and WBCT30 for detecting the resolution or reoccurrence of coagulopathy and identifies how these findings, if confirmed, may be used to increase the efficacy and efficiency of antivenom treatment in the field.(AU)

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.