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

Table 3 Description, characteristics, and response to initial antivenom therapy in 17 patients with abnormal WBCT results

Case n.	WBCT20 ≠ WBCT30	Sex	Age	Snake species	Delay (hours)	Stage of edema/bleeding	HCT at H₀ (%)	N. vials AA at H_a	Initial WBCT20 at H₀	Initial WBCT30 at H₀	1^st Normal WBCT20 at H_a	1^st Normal WBCT30 at H_a	External bleeding arrested at H_a
1	Group 3a Group 4	M	7	Echis	72	E5, B4	24.4	H₀ = 2 H₃ = 2	No clot	No clot	H₃	H₃	H₆
2	Group 2	M	9	Echis	12	E3, B5	13.0	H₀ = 2	No clot	No clot	H₂₄	H₄₈	H₃
3	Group 2 Group 3b	M	7	Echis	24	E2, B3	40.0	H₀ = 2	No clot	No clot	H₁₂	H₆	H₃
4	Group 1	M	42	Bitis	20	E5, B1	31.0	H₀ = 2	Weakly friable	Improved friable	H₃	H₃	H₃
5	Group 2 Group 4	M	15	Echis	48	E5, B5	14.0	H₀ = 2 H₆ = 2	No clot	No clot	H₃	H₆	H₁₂
6		M	25	Echis	192	E2, B4	31.6	H₀ = 2	No clot	No clot	H₃	H₃	H₃
8		M	41	Echis	120	E1, B4	42.0	H₀ = 2	No clot	No clot	H₃	H₃	H₃
10	Group 3a Group 4	M	18	Echis	96	E2, B5	21.0	H₀ = 2 H₃ = 2	No clot	No clot	H₆	H₆	H₁₂
12	Group 3a	M	25	Echis	1	E1, B3	35.0	H₀ = 2 H₃ = 2	No clot	No clot	H₆	H₆	H₆
13	Group 2	M	20	Echis	72	E3, B4	36.0	H₀ = 2	No clot	No clot	H₃	H₂₄	H₃
^a15	Group 1	F	18	Bitis	72–168	E1, B1	32.3	H₀ = 1	Friable	Normal	H₃	N/A	Before arrival
^b17	Group 1	M	30	Echis	120	E2, B5	39.0	H₀ = 2	Friable	No clot	H₃	H₃	Internal only
18		M	25	Echis	4	E2, B3	N/A	H₀ = 2	No clot	No clot	H₃	H₃	H₃
19	Group 2	F	15	Echis	72	E3, B5	24.0	H₀ = 2	No clot	No clot	H₃	H₆	H₃
20	Group 2	M	35	Echis	3	E1, B4	36.0	H₀ = 2 H₃ = 2	No clot	No clot	H₂₄	H₇₂	H₆
^c22	Group 3b	F	12	Echis	24	E2, B5	11.0	H₀ = 2	No clot	No clot	H₆	H₆	H₃
23	Group 2	M	22	Echis	69	E2, B5	11.0	H₀ = 2	No clot	No clot	H₆	H₂₄	H₃

^a15 = Patient alternately stated that the bite occurred either 3 or 7 days earlier; abnormal local bleeding reportedly began 48 h after the bite but resolved shortly before she came to the hospital. Freshly dried blood was visible around the bite site
^b17 = Hematemesis and gingival bleeding resolved shortly before arrival, but he presented with gross hematuria and signs of subarachnoid hemorrhage (widening pulse pressure with systolic hypertension; bradycardia; irregular breathing; altered mental status). Signs of increased intracranial pressure resolved between H₁₂ and H₂₄. There was still gross hematuria when the patient discharged himself against medical advice at H₁₄₄, but the overall clinical picture suggested that kidney injury rather than active venom was causing the issue at the time of discharge
^c22 = Gingival bleeding stopped after antivenom at H₀. No WBCT taken at H₃, but WBCT20 and WBCT30 were both normal at H₆

ISSN: 1678-9199