Incidence of Snakebite Associated Thrombotic Microangiopathy & Role of Peripheral Blood Smear as a Predictor of Clinical Outcome
Incidence of Snakebite Associated Thrombotic Microangiopathy & Role of Peripheral Blood Smear as a Predictor of Clinical Outcome
The aim of this study is to find the overall incidence of thrombotic microangiopathy in
 snakebite victims. As we know snakebite is a common in tropical regions. Many a times the
 early diagnosis of TMA is missed and precious time which could have helped in improving the
 patient prognosis is lost. Also via this study we wish to learn the role of cost effective
 test like peripheral smear which could help learn morphological picture of red blood cells
 and thus help in early prediction of patients clinical prognosis.
All snakebite patients brought to emergency department with history of bite and prolonged
 whole blood clotting time (WBCT) will be included in the study . their samples for hemogram,
 RFT and LDH would be collected in corresponding tubes . from sample for hemogram a peripheral
 blood smear (PBS) would be prepared , also the sample would be checked for direct coomb's
 test (DCT) positivity. DCT positive patients would be excluded from study . Also patients who
 received blood or blood components from outside hospital or patients with known history of
 hemolytic disease or patients on anti platelets or anticoagulants would also be excluded from
 this study .

 thus patients who meet the exclusion and inclusion criteria would be followed up after 48
 hours and their hemogram , RFT and LDH would be re assessed to check for presence of
 hemolysis , thrombocytopenia and acute kidney injury(AKI) .From the hemogram sample PBS would
 be prepared to check for presence of schistocytes.

 Here we aim to study for incidence of TMA - defined as presence of MAHA( microangiopathic
 hemolytic anemia ) , thrombocytopenia and presence of AKI . MAHA is detected as drop of hb,
 presence of schistocytes in PBS , increase in LDH and increase in retic count. India is a
 tropical country and the southern state of Kerala , this study is done with the purpose of
 finding the prevalence of TMA among patients of snakebite brought to a tertiary care centre.
 Most often the victims are farmers or people from middle class. A cost effective test such as
 peripheral smear can help in predicting the prognosis and thereby aid in deciding whether the
 patient should require a multi disciplinary treatment early on and thereby play a pivotal
 role in saving patient life as well as provide an economical solution.
Inclusion Criteria:

 -  All patients with a history of snakebite and with prolonged WBCT.

 Exclusion Criteria:

 -  Patients administered with blood or blood components prior to admission

 -  Known case of bleeding disorders

 -  Known case of haemolytic anaemia

 -  Patients on antiplatelets or anticoagulants