Scientific letters

A case report of detecting subclinical coagulopathy in a patient with boomslang (Dipholidus typus) bite

Mungela J. Tambwe, Vidya Lalloo, Andreas Engelbrecht, Pholosho Pelle
South African Family Practice | Vol 63, No 1 : Part 3| a5299 | DOI: https://doi.org/10.4102/safp.v63i1.5299 | © 2021 Mungela J. Tambwe, Vidya Lalloo, Andreas Engelbrecht, Pholosho Pelle | This work is licensed under CC Attribution 4.0
Submitted: 16 March 2021 | Published: 11 August 2021

About the author(s)

Mungela J. Tambwe, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Vidya Lalloo, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Andreas Engelbrecht, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Pholosho Pelle, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa


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Abstract

The boomslang (Dipholidus typus) has a predominantly haemotoxic venom. Because of the consumptive nature of the coagulopathy, signs and symptoms are usually delayed by up to 72 h after the bite. Traditional laboratory coagulation assays have a long turnaround time, by which time the patient’s bleeding and clotting profile has changed. A 25-year-old male patient was bitten by a boomslang. Despite two normal laboratory coagulation assay results, a point-of-care rotational thromboelastometry showed low fibrinogen levels, leading to the administration of monovalent antivenom. This report highlights the value of point-of-care thromboelastometry in the care of patients with subclinical boomslang envenomation.

Keywords

boomslang bite; monovalent antivenom; haemotoxic envenomation; snake bite; rotational; thromboelastometry (ROTEM)

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