Persistent fibrinogen deficiency after snake bite: A case report

Abstract

BACKGROUND Venom-induced consumption coagulopathy (VICC) is characterized by coagulation dysfunction accompanied by decreased coagulation factor activity and fibrinogen (FBG) concentrations. We report a patient with VICC caused by snake bite who manifested persistent FBG deficiency without abnormal coagulation factor activity. This information may be helpful in diagnosing and treating VICC. CASE SUMMARY A 49-year-old man who had been bitten by a snake 13 h previously was admitted to the Emergency Department of our hospital with visible swelling of a finger and a bleeding puncture site. The provisional diagnosis was VICC, this being made based on persistent bleeding from the puncture site and subcutaneous hemorrhage. Laboratory evidence of coagulation abnormalities, including fibrinolysis, and findings on thromboelastography confirmed VICC. He had persistent afibrinogenemia requiring intravenous infusions of cryoprecipitate and fresh frozen plasma, together with continuous large doses of human FBG. After this treatment, the patient’s right upper limb swelling improved significantly and his subcutaneous hemorrhage resolved. All of his abnormal laboratory findings returned to normal by day 25. During 6 months’ of follow-up, the patient had no further hemorrhagic events. CONCLUSION Hemorrhagic snake venom can result in coagulation dysfunction characterized by persistent FBG deficiency without abnormal coagulation factor activity.

Echis carinatus snakebite, a rare case of fatal envenomation in a young Pakistani boy: a case report.

“…Consumptive coagulopathy that mostly accompanied Viperidae snake bites, is VICC 13,3 . Venom Induced Consumptive Coagulopathy is often characterized by undetectable PT prolongation, increased INR, and usually accompanied by a signi cant increase in D-dimer concentration 14,10 . Coagulopathy caused by VICC can result in intravascular hemolysis, hypotension, or nephrotoxicity to renal cells and vasculature, ultimately leading to renal failure 4 , as visualized in the case of our patient.…”