Xu MH, Li J, Han L, Chen C. Persistent fibrinogen deficiency after snake bite: A case report. World J Clin Cases 2021; 9(33): 10355-10361 [PMID: 34904110 DOI: 10.12998/wjcc.v9.i33.10355]
Corresponding Author of This Article
Chao Chen, MD, PhD, Doctor, Research Fellow, Surgeon, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. chenchao027@163.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2021; 9(33): 10355-10361 Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10355
Persistent fibrinogen deficiency after snake bite: A case report
Meng-Hao Xu, Jing Li, Liang Han, Chao Chen
Meng-Hao Xu, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Jing Li, Liang Han, Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Chao Chen, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Chao Chen, Department of Orthopaedics, Hefeng Central Hospital, Enshi 445800, Hubei Province, China
Author contributions: Xu MH and Chen C designed the research study; Xu MH, Li J and Han L performed the research; Xu MH, Li J and Chen C analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao Chen, MD, PhD, Doctor, Research Fellow, Surgeon, Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. chenchao027@163.com
Received: July 8, 2021 Peer-review started: July 8, 2021 First decision: July 26, 2021 Revised: July 30, 2021 Accepted: September 8, 2021 Article in press: September 8, 2021 Published online: November 26, 2021 Processing time: 136 Days and 19.4 Hours
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.
Core Tip: Venom-induced consumption coagulopathy (VICC) is characterized by decreased coagulation factor activity and fibrinogen (FBG) deficiency. Hemorrhage-inducing snake venom contains several ingredients that directly or indirectly consume fibrinogen through multiple mechanisms. We report a rare case with persistent afibrinogenemia without abnormal coagulation factor activity after snake bite. Our report may assist the diagnosis and treatment of FBG deficiency in patients with VICC.
