{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:04:31Z","timestamp":1784307871692,"version":"3.55.0"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Snakebite envenomation remains a significant yet often overlooked health challenge in Nepal, particularly in its rural and hilly regions. While venom\u2010induced consumption coagulopathy (VICC) is commonly observed with viper bites, microangiopathic hemolytic anemia (MAHA) is an extremely rare complication, especially with green pit vipers (\n                    <jats:italic>Trimeresurus<\/jats:italic>\n                    spp.). MAHA is often underdiagnosed in low\u2010resource settings due to the absence of definitive laboratory diagnostics. We report a case of a 47\u2010year\u2010old woman from rural Nepal who was bitten by a presumed green pit viper (\n                    <jats:italic>Trimeresurus<\/jats:italic>\n                    spp.). She developed local swelling, ecchymosis, hematuria, anemia, thrombocytopenia, and coagulopathy. MAHA was diagnosed clinically based on syndromic presentation and serial hematologic monitoring, despite the unavailability of a peripheral blood smear. Due to species\u2010specific antivenom unavailability, the patient was treated with supportive care and blood product transfusions, and she achieved complete recovery without any renal complications. This case highlights the diagnostic challenges of MAHA in settings lacking definitive laboratory tests. It emphasizes the importance of clinical vigilance and syndromic diagnosis. Prompt, appropriate supportive management can lead to favorable outcomes even without antivenom availability. MAHA should be considered in snakebite victims presenting with thrombocytopenia and anemia. Strengthening diagnostic capacity and improving access to species\u2010specific antivenoms are critical for reducing morbidity and mortality from snakebite envenomation in resource\u2010limited settings.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.73002","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T03:26:31Z","timestamp":1782098791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosing Syndrome\u2010Like Microangiopathic Hemolytic Anemia After Pit Viper Envenomation: Overcoming Laboratory Gaps in a Resource\u2010Limited Setting: A Case Report From Nepal"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4834-9354","authenticated-orcid":false,"given":"Prabhat","family":"Kaphle","sequence":"first","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0892-2050","authenticated-orcid":false,"given":"Pukar","family":"Gupta","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarjan","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Surkhet Provincial Hospital  Surkhet Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeru","family":"Diyali","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6946-6435","authenticated-orcid":false,"given":"Raj Kumar","family":"Koirala","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrita","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Bhojpur District Hospital  Bhojpur Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9542-9964","authenticated-orcid":false,"given":"Dhanlaxmi","family":"Giri","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1148-3751","authenticated-orcid":false,"given":"Nabin","family":"Pahari","sequence":"additional","affiliation":[{"name":"Mercy City Hospital  Butwal Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil Kumar","family":"Sah","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5292-2087","authenticated-orcid":false,"given":"Kamal","family":"Hamal","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8326-1659","authenticated-orcid":false,"given":"Sujan","family":"Bohara","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0011572"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(22)00028\u20106"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2018.11.001"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.63"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins14010057"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010019\u20101133\u20102"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11239\u2010019\u201001868\u2010z"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.IJO_1764_21"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.29333\/jcei\/11514"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2012.03.015"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2006.03.008"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2019.03.015"}],"container-title":["Clinical 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