Snake Bite Induced Coagulopathy: A Study of Clinical Profi le and Predictors of Poor Outcome
Background: Snake bite poisoning is known to man since antiquity. 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 hemorrhage, infarction and even death if the treatment is delayed. In tropical countries where snake bite is a serious problem
there is very little reliable data on hematological problems of snake envenomation because of inadequate documentation.
Aims: The present study was undertaken to study the clinical profi le 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.
Material and Methods: Fifty patients consecutively admitted with history of snakebite were studied from May 2012 to November
2013 in a Kempegowda institute of medical sciences (KIMS), Bangalore, Karnataka, India. The patients were classifi ed into the
normal and coagulopathy group based on clinical symptoms and the hematological parameters.
Results: In our study patients who had coagulopathy had prolonged hospital stay and requirement of more blood products
transfusion causing increased morbidity. 24 patients had platelets less than 1 lakh and approximately hospitalized for 28 days
and they received 102 platelet units. INR was more than 1.5 in 24 patients and hospitalized for 25 days and they received 136
fresh frozen plasma. The case-fatality rate in our study was 4%.
Conclusion: Combined clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce
the hospital stay and mortality.
animal exposures. 18th ed. Chapter 391. In: Harrison’s Principles of Internal
Medicine, Fauci, Braunwald, Kasper, Hanser Longo, Jameson, Loscalzo,
eds. New York: McGraw-Hill Mechanical Publishing Division; 2008;2741
2. Lívia SR, Glória Elisa MF, Carla CP, Emmanuel BA. Acute Kidney Injury
Caused by Bothrops Snake Venom. Nephron Clin Pract 2011;119:131-7.
3. Kumar K.P.G. Haematotoxic snake envenomation – Prothrombin time is a
better predictor of mortality. Amrita J of Medicine. 2011;7 (2):41-44
4. Lee JA, Kim SY, Hyun SC, Park SM, Park JS, Kim GT. Clinical features in
snake bite. J Korean Soc Emerg Med. 1996;7:580-589
5. Han BG, Choi SO, Kim HY, Kang NK, Ryu JS, Lee KH. A study
of the complication of poisonous snake bite. Korean J Intern Med.
6. Hasiba U, Rosenbach LM, Rockwell D., Lewis JH. DIC-like syndrome
after envenomation by the snake, Crotalus horridus horridus. N Engl J Med.
7. Levi M. Disseminated intravascular coagulation: what’s new? Crit Care
8. Bick RL. Disseminated intravascular coagulation, current concepts of
etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin
North Am. 2003;17:149-176.
9. Bakshi SA. Snake bites in rural area of Maharashtra state, India. Trop Doct.
10. Kalantri S, Singh A et al. Clinical predictors of in-hospital mortality in
patients with snake bite: a retrospective study from a rural hospital in central
India. Tropical Medicine and International Health. 2006;11 (1):22-30.
11. Gold BS, Dart RC & Barish RA. Bites of venomous snakes. New England
Journal of Medicine. 2002;347:347-356.