Hematological Abnormalities in Indian Common Krait Envenomation

INTRODUCTION: Snake bite is usually associated with hematological abnormalities.(1) Indian common krait (Bungarus caeruleus) toxin acts pre-synaptic in neuromuscular junction leading to pure neuro-paralysis. There has been some reports of venom induced TTP but no clear documentation of venom resulting in hematological abnormalities. OBJECTIVE: Is too look for hematological abnormalities in common krait envenomation. PATIENTS AND METHODS: 22 cases of neuroparalytic snake envenomation attributed to Indian common krait were included in this prospective study. Detailed history, clinical examination, complete blood counts, routine biochemistry and coagulogram were recorded at admission (day 0), 24, 48 hours, day 7,14 and 28. The duration of hospital stay and outcomes were recorded. All the patients were admitted in high dependency unit at our institute and given standard treatment with anti-snake venom. Supportive therapy in the form of oxygenation and ventilation was provided as clinically indicated. Results are presented as trend of hematological and coagulation abnormalities noted. RESULTS: The mean age of patients was 31 years. All the patients had clinical evidence of Neuro-paralysis and required mechanical ventilation support. Average bite to ASV time was 407 minutes. Mean duration of hospitalization was 3days. All 22 patients survived. The trend of hematological abnormalities have been depicted in figure 1. There was no significant fever, features of SIRS or bleeding observed at any stage. There was no significant increase or decrease in haemoglobin noted but leukocytosis, dominant neutrophilic was noted on day 1. This persisted for 48 hours and by day 3 leukocytosis started settling. Day 7 and day 28 values were nearly the same. The platelet count remained normal throughout the stay but the day 1-day 3 values were slightly lower than day 7,14 and day 28 values. CONCLUSION: Anemia in snake bite could be either due to haemolysis/DIC or immunological phenomenon(2) but was absent in our patients. Raised leaucocyte counts is possibly due to SIRS. Common krait envenomation did not very significantly alter hematological parameters except for some leukocytosis observed on first 72 hours.