Larréché Sébastien, Chacha Roland Benes, Sodjinou Noé, Ouorou Seidou Alassane, Ganhouingnon Eric, Layo Edith Aloukoutou, Mégarbane Bruno, Massougbodji Achille, Chippaux Jean-Philippe
Department of Medical Biology, Bégin National Military Teaching Hospital, F-94160 Saint-Mandé, France.
Inserm UMRS-1144, Université Paris Cité, F-75006 Paris, France.
Toxins (Basel). 2024 Dec 24;17(1):3. doi: 10.3390/toxins17010003.
envenomings are a public health problem in West Africa, leading to bleeding and hypocoagulability. The aim of this study was to assess the hemostasis disorders associated with envenoming. Envenomed patients with an abnormal whole blood clotting test (WBCT) were prospectively included at Tanguiéta, Benin. A WBCT with a sequential reading (i.e., at 20, 30, and 60 min), viscoelastic analysis (VA) using the Quantra analyzer, and blood count were performed on admission. VA and the WBCT were also assessed at 4, 8, 12, 24, 48, and 72 h after antivenom administration. Nineteen patients were included. On admission, the main results were an absence of a clot on VA and a slight decrease in platelets. Clot time gradually decreased over time while clot stiffness, fibrinogen, and platelet contributions to stiffness increased. Sequential reading improved the sensitivity of the WBCT. At H48, all patients with recurrence bleeding after antivenom administration had an abnormal WBCT while patients with a normal WBCT never had bleeding during their follow-up. VA allows the identification of various hemostasis disorders. Hypofibrinogenemia was the main disorder that persisted for several days after treatment. A WBCT with a sequential reading is an effective alternative for monitoring hypocoagulability in the absence of a laboratory.
蛇咬伤中毒是西非的一个公共卫生问题，可导致出血和低凝状态。本研究的目的是评估与蛇咬伤中毒相关的止血障碍。在贝宁的坦吉埃塔，对全血凝血试验（WBCT）异常的蛇咬伤中毒患者进行前瞻性纳入。入院时进行了连续读数（即20、30和60分钟时）的WBCT、使用Quantra分析仪的粘弹性分析（VA）以及血细胞计数。在给予抗蛇毒血清后的4、8、12、24、48和72小时也评估了VA和WBCT。纳入了19名患者。入院时，主要结果是VA显示无凝块形成，血小板略有减少。凝块时间随时间逐渐缩短，而凝块硬度、纤维蛋白原以及血小板对硬度的贡献增加。连续读数提高了WBCT的敏感性。在48小时时，所有给予抗蛇毒血清后出现复发出血的患者WBCT均异常，而WBCT正常的患者在随访期间从未出血。VA可识别各种止血障碍。低纤维蛋白原血症是治疗后持续数天的主要障碍。在没有实验室的情况下，连续读数的WBCT是监测低凝状态的有效替代方法。
