USE OF 20 MINUTE WHOLE BLOOD CLOTTING TIME IN PATIENTS OF SNAKEBITE; AN EXPERIENCE FROM KOHAT, KHYBER PAKHTUNKHAH: Blood Clotting Time in Patients of Snakebite

Hammad Javed; Tariq Bashir; Atif Rauf; Syed Murtaza; Raja Jibran

doi:10.51253/pafmj.v71i5.3684

Authors

Hammad Javed Combined Military Hospital Mangla/National University of Medical Sciences (NUMS) Pakistan
Tariq Bashir Combined Military Hospital Kohat/National University of Medical Sciences (NUMS) Pakistan
Atif Rauf Armed Forces Institute of Cardiology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Syed Murtaza Combined Military Hospital Loralai/National University of Medical Sciences (NUMS) Pakistan
Raja Jibran Combined Military Hospital Skardu/ National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v71i5.3684

Keywords:

Anti snake venom, Russel viper, Snakebite, Neurotoxic, Hemotoxic, 20-minute whole blood clotting time

Abstract

Objective: To study the diagnostic accuracy of 20-minute whole blood clotting time in hemotoxic snakebite.

Study Design: Cross sectional validation study.

Place and Duration of Study: Combined Military Hospital Kohat Pakistan, from Jul 2015 to Jun 2017.

Methodology: Study included 52 patients who presented with the complaint of a snakebite. The data was recorded on predesigned proforma including clinical, laboratory features. All the patients were kept indoor for observation for a minimum of 72 hours from the time of presentation.

Results: The study showed that males were more affected with age group between 20-50 years. Most common presenting features were local swelling 33 (71%) and pain and most common snakebite type was hemotoxic 33 (71%). The 20-minute whole blood clotting time was found to have low sensitivity (61%) and specificity (58%). A significant association was found between the dose of anti-snake venom and severity of coagulopathy (p<0.001), respiratory failure (p<0.001) and development of side effects due to anti snake venom (p<0.001). The mortality rate was 6.5% and was significantly related to age of the victims (p=0.003). The diagnostic accuracy of 20-minute whole blood clotting time was 60.25%.

Conclusion: The use of 20-minute whole blood clotting time can not only be misleading but also a source of delay in administering anti snake venom given the low sensitivity and specificity and high false negative rate.