Utility of Clot Waveform Analysis in Russell's Viper Bite Victims with Hematotoxicity

Siju V Abraham, Aboobacker Mohamed Rafi, S Vimal Krishnan, Babu Urumese Palatty, Susheela J Innah, Jerry Johny, Salish Varghese, Siju V Abraham, Aboobacker Mohamed Rafi, S Vimal Krishnan, Babu Urumese Palatty, Susheela J Innah, Jerry Johny, Salish Varghese

Abstract

Introduction: In Russell's viper bites, due to the lack of a better alternative, whole blood clotting test (WBCT) remains the standard test even though its reliability and sensitivity has been shown to be low. Activated partial thromboplastin time (aPTT)-based clot waveform analysis (CWA) is an optic absorbance assay that can be used as a global clotting test. In this study, the objective was to assess the changes in CWA and to compare CWA to WBCT and aPTT in patients with Russell's viper envenomation.

Methods: The datum was collected prospectively over 2 months as a pilot observational study in a tertiary care center. All proven cases of Russell's viper-envenomated individuals with preliminary CWA data and WBCT were included in the study. The clot wave (CW) of the five individuals, which met all the stringent inclusion criteria, was analyzed and interpreted.

Results: CW absorbance sigmoid waveform was deranged in all 5 cases, of which 4 showed a change in CWA even before an abnormal aPTT. Three of the 5 had a normal WBCT but showed early changes in CWA. Atypical biphasic waveform reported in disseminated intravascular coagulation in other prior studies is seen in venom-induced consumptive coagulopathy also. In all patients where a second derivative was plotted, the second (lower) phase of the second derivative showed a slow rise to baseline.

Conclusion: CWA showed changes which provided information earlier than the conventional coagulation studies in the snakebite victims studied. While aPTT or WBCT reflects clotting time, CWA conveys the dynamic process of clot formation and stabilization. CWA may reveal disorders of clotting in snakebite victims before the conventional tests become abnormal. Future research should assess the speed and accuracy of the test in diagnosing hemotoxic envenomation and its potential role in guiding antivenom therapy.

Keywords: clot waveform analysis; hematotoxic envenomation; snake.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram: Inclusion and exclusion of participants
Figure 2
Figure 2
Clot waveform of normal plasma by monitoring of absorbance. (a) Normal “S” clot reaction curve showing the phases of the clotting reaction, change in absorbance (Y-axis) versus acquisition time (X-axis). Indicates the activated partial thromboplastin time value on X-axis. The upper blue-colored trace shows the changes in absorbance observed during the performance of activated partial thromboplastin time with normal reference plasma. The clot waveform is comprised of five main phases: delay (0-A), baseline (A-B), acceleration (B-C), deceleration (C-D), and end point (D-E). (b) The purple-colored curve is the first derivative of the absorbance corresponding to the coagulation velocity. The light blue-colored biphasic curve is the second derivative of the absorbance corresponding to the coagulation acceleration
Figure 3
Figure 3
Clot waveforms of individual patients. (a) Patient 1, (b) Patient 2, (c) Patient 3, (d) Patient 4, (e) Patient 5

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Source: PubMed

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