Reliability of the simple 20 minute whole blood clotting test (WBCT20) as an indicator of low plasma fibrinogen concentration in patients envenomed by Bothrops snakes

Sano-Martins, Ida Sigueko; Fan, Hui Wen; Castro, S. C. B.; Tomy, Sandra C.; França, Francisco Oscar Siqueira; Jorge, Miguel Tanús; Kamiguti, Aura S.; Warrell, David A.; Theakston, R.D.G.

doi:10.1016/0041-0101(94)90388-3

Cited by 117 publications

(68 citation statements)

References 7 publications

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“…Venom-induced consumption coagulopathy was detected using the 20-minute whole blood clotting test. 13,14 Statistical analysis. Proportions and percentages were used to describe the clinical characteristics of snake bites.…”

Section: Methodsmentioning

confidence: 99%

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Ariaratnam¹,

Sheriff²,

Arambepola³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

102

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Abstract. Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russell's vipers ( Daboia russelii ) and hump-nosed pit vipers ( Hypnale hypnale ) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. Distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in Sri Lanka where the biting species is unknown. Diagnostic sensitivities and specificities of these syndromes for envenoming were 78% and 96% by Naja naja , 66% and 100% by Bungarus caeruleus , 14% and 100% by Daboia russelii , and 10% and 97% by Hypnale hypnale , respectively. Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by H. hypnale who will not benefit from existing antivenoms. The technique of hospital-based collection, labeling and preservation of dead snakes brought by bitten patients is recommended for rapid assessment of a country's medically-important herpetofauna.

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Section: Methodsmentioning

confidence: 99%

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Ariaratnam¹,

Sheriff²,

Arambepola³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

102

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“…[18][19][20] Two milliliters of venous blood was placed in a new, clean, dry glass test tube and left undisturbed for 20 min at room temperature. The tube was then tipped to see if the blood was completely liquid (non-clotting) or whether it contained any clot (clotted).…”

Section: Methodsmentioning

confidence: 99%

A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.

Ariaratnam¹,

Meyer²,

Perera³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Russell's viper is the most important cause of life-threatening snake bite and acute renal failure in Sri Lanka. Only equine polyspecific antivenoms imported from India are available. They have not proved effective clinically or in clearing venom antigenemia and they frequently cause reactions. In an attempt to reduce mortality and morbidity, a new monospecific ovine Fab fragment antivenom (PolongaTab ; Therapeutic Antibodies, Inc., London, United Kingdom) was raised against Sri Lankan Russell's viper venom. In a preliminary dose-finding study in 35 patients, an initial dose of 3-4 g restored blood coagulability permanently and stopped systemic bleeding, even in severely envenomed patients. Venom antigenemia disappeared within 1 hr of antivenom treatment but recurred, probably as a result of continued absorption of venom from the site of the bite, after the rapid clearance of therapeutic antibody. Twelve patients (34%) experienced early reactions that were usually mild and always responded to epinephrine.

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“…Enquanto um dos tubos era inclinado no sentido da posição horizontal, suave e periodicamente, com o objetivo de verificar se o sangue estava líquido e escorria por sua parede ou se havia coagulado, o outro tubo servia como controle do resultado obtido com o primeiro. Considerou-se como presença de sangue incoagulável a ausência de coagulação após a observação do sangue por 20 minutos 49 .…”

Section: Methodsunclassified

Fatores associados à incoagulabilidade sangüínea no envenenamento por serpentes do gênero Bothrops

Oliveira

Ribeiro

Jorge

2003

Rev. Soc. Bras. Med. Trop.

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Resumo Com o objetivo de conhecer fatores associados à incoagulabilidade sangüínea no envenenamento botrópico, foram obtidas informações de 2.991 prontuários médicos de pacientes atendidos no Instituto Butantan de 1981 a 1990. Associaram-se positivamente à incoagulabilidade sangüínea (p<0,05): picadas no final do ano e em extremidades dos membros inferiores; dor, edema e equimose local; hemorragia e choque; dose de antiveneno; tempo do acidente à chegada ao Instituto Butantan. Associaram-se negativamente à incoagulabilidade (p<0,05): tamanho de Bothrops jararaca; uso de torniquete; tempo entre a chegada ao Instituto Butantan e o início da administração do antiveneno. Não se associaram à incoagulabilidade (p>0,05): horário do acidente; presença de presa recém-deglutida no tubo digestivo da serpente; sexo e idade do paciente; ocorrência de bolha, necrose, abscesso e incisão local, amputação, insuficiência renal e óbito. Pode-se concluir que, embora a incoagulabilidade sangüínea apresente associação com manifestações precoces do envenenamento, não tem boa associação com a evolução clínica do paciente. Palavras-chaves: Bothrops jararaca. Coagulação sangüínea. Fatores prognósticos.Abstract This study aimed at assessing, in the envenoming by Bothrops, factors that are associated with blood incoagulability. Information was obtained from the charts of 2,991 patients admitted to Instituto Butantan, from 1981 to 1990. Factors positively associated with blood incoagulability (p<0.05) were: snake bite in the late months of the year; bites in the distal segments of the lower limbs; pain, edema, and bruising at the bite site; systemic bleeding and shock; dose of antivenom administered; time between bite and admission to Instituto Butantan. Size of the snake Bothrops jararaca; use of a tourniquet; and time between arrival to Instituto Butantan and start of the antivenom administration were negatively associated with blood incoagulability (p<0,05). Factors not associated with blood incoagulability (p>0.05) were: time of the bite; presence of recently swallowed prey in the snake gut; gender and age of the patient; blister, necrosis, and abscess at the bite site; occurrence of amputation, renal failure and death; presence of an incision at the bite site. We conclude that although blood incoagulability is associated with early manifestations of Bothrops envenoming, it is not associated with the clinical outcome. Key-words: Bothrops jararaca. Blood coagulability. Prognostic factors.

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Reliability of the simple 20 minute whole blood clotting test (WBCT20) as an indicator of low plasma fibrinogen concentration in patients envenomed by Bothrops snakes

Cited by 117 publications

References 7 publications

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

A new monospecific ovine Fab fragment antivenom for treatment of envenoming by the Sri Lankan Russell's viper (Daboia Russelii Russelii): a preliminary dose-finding and pharmacokinetic study.

Fatores associados à incoagulabilidade sangüínea no envenenamento por serpentes do gênero Bothrops

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