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Table 5 Resumption and resolution of coagulopathy by WBCT20 and WBCT30 in seven patients with Echis envenomations

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

Case No. aDiscrepancies in secondary events Secondary resumption –WBCT20 at Ha Secondary resumption –WBCT30 at Ha Recurrence of symptoms Additional AA given Final control WBCT20 at Ha Final control WBCT30 at Ha Resolution of symptoms
1 Initial detection (Group 3a) Remained normal H6 No, patient improving No H3, no resumption H24 H6
2 No H72 H72 Diffuse pain and headache 2 vials at H72 H120 H120 ≤ H96
a3 Final resolution (Group 3b) H72 H72 Edema and blistering No, due to H0 anaphylaxis H144 H192 H192
b10 Initial detection (Group 3a) H48 H27 Internal bleeding 2 vials at H48 H120 H120 ≤ H72
12 Initial detection (Group 3a) Remained normal H24 No, patient improving No H6, no resumption H48 H6
c19 No H24 H24 Gingival bleeding 2 vials at H24 H72 H72 H27
d22 Transient resolution (Group 3b) H96 and H168 H96 Internal bleeding 2 vials at H120
2 vials at H168
H240 H240 H192
  1. a3 = We elected to manage the secondary recurrence of envenomation symptomatically for as long as possible because the patient had already experienced two separate anaphylactoid reactions and there were very limited resources on hand for resuscitating a pediatric cardiac arrest
  2. b10 = The patient presented with a subarachnoid hemorrhage at H0 which initially resolved by H19, but signs and symptoms returned at H27 in conjunction with a recurrence of coagulopathy by WBCT30. At H48, his WBCT20 also turned positive. He was treated with additional two vials of antivenom at this time and made a full recovery without sequelae
  3. c19 = Gingival bleeding resumed at H24 after initially resolving at H6
  4. d22 = Two separate resumptions occurred with this patient. Resumption of WBCT20 and WBCT30 was recorded at H96, but most likely began around H72 when signs of intraperitoneal hemorrhage began to occur. The test was normal at H48, but could not be collected at H72