{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:00:35Z","timestamp":1790694035198,"version":"4.1.0"},"reference-count":11,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,14]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>A woman in her 30s presented with severe haemotoxic snake envenoming complicated by venom-induced consumptive coagulopathy (VICC) and early multiorgan involvement. Despite receiving adequate polyvalent anti-snake venom and initial transfusions at a referral facility, the patient\u2019s coagulopathy persisted. On arrival at our emergency department, conventional coagulation tests (prothrombin time and international normalised ratio) were only mildly abnormal, in contrast to her significant clinical severity. Rotational thromboelastometry (ROTEM) revealed severe hypocoagulability with markedly impaired clot formation and strength. Additional targeted transfusions guided by viscoelastic findings successfully corrected major coagulation defects and resulted in clinical improvement. This case highlights the limitations of conventional coagulation tests in assessing the true functional severity of VICC and demonstrates the practical value of ROTEM in guiding targeted therapy for acute haemotoxic snakebites.<\/jats:p>","DOI":"10.1136\/bcr-2026-274731","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:32:14Z","timestamp":1790692334000},"page":"e274731","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rotational thromboelastometry guided transfusion in venom-induced consumptive coagulopathy following a haemotoxic snakebite"],"prefix":"10.1136","volume":"19","author":[{"given":"Miriyala","family":"Gaayathri","sequence":"first","affiliation":[{"name":"Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrithanand","family":"VT","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjupriya","family":"G","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manu","family":"Ayyan","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092907202249000_19.9.e274731.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012080","article-title":"Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality","volume":"18","author":"Afroz","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"2026092907202249000_19.9.e274731.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013334","article-title":"Pre-hospital interventions in snakebite: A telephonic survey and follow up investigating snakebite envenoming from a tertiary care centre in Coastal Karnataka","volume":"19","author":"Wagle","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"2026092907202249000_19.9.e274731.3","doi-asserted-by":"crossref","DOI":"10.3390\/toxins12090583","article-title":"Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite","volume":"12","author":"Wedasingha","year":"2020","journal-title":"Toxins (Basel)"},{"key":"2026092907202249000_19.9.e274731.4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/14782715221126770","article-title":"Venom induced consumption coagulopathy and performance of 20-min whole blood clotting test for its detection in viperid envenomation","volume":"52","author":"Rajkumar","year":"2022","journal-title":"J R Coll Physicians Edinb"},{"key":"2026092907202249000_19.9.e274731.5","doi-asserted-by":"publisher","DOI":"10.1177\/03000605211067321"},{"key":"2026092907202249000_19.9.e274731.6","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/trstmh\/trab052","article-title":"Comparison of rotational thromboelastometry parameters with 20-minute whole blood clotting test as a predictor of envenoming in Russell\u2019s viper bite patients","volume":"115","author":"Gooneratne","year":"2021","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2026092907202249000_19.9.e274731.7","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2016.1263857"},{"key":"2026092907202249000_19.9.e274731.8","unstructured":"National Centre for Disease Control, Ministry of Health and Family Welfare, Government of India . National Centre for Disease Control, Ministry of Health and Family Welfare, Government of India. National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE). 2024. Available: https:\/\/ncdc.mohfw.gov.in\/uploads\/pdf\/NATIONAL-ACTION-PLAN-FOR-PREVENTION-AND-CONTROL-OF-SNAKEBITE-ENVENOMING-NAPSE.pdf [Accessed 19 Jul 2026]."},{"key":"2026092907202249000_19.9.e274731.9","doi-asserted-by":"crossref","first-page":"211","DOI":"10.4103\/JETS.JETS_43_17","article-title":"Utility of Clot Waveform Analysis in Russell\u2019s Viper Bite Victims with Hematotoxicity","volume":"11","author":"Abraham","year":"2018","journal-title":"J Emerg Trauma Shock"},{"key":"2026092907202249000_19.9.e274731.10","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2023-258319","article-title":"The use of rotational thromboelastometry to guide management following Bitis nasicornis envenoming","volume":"17","author":"Nye","year":"2024","journal-title":"BMJ Case Rep"},{"key":"2026092907202249000_19.9.e274731.11","doi-asserted-by":"crossref","first-page":"746","DOI":"10.4269\/ajtmh.21-0875","article-title":"Case Report: Rotational Thromboelastometry in Taipan Envenomation","volume":"106","author":"Tacon","year":"2022","journal-title":"Am J Trop Med Hyg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274731","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:32:17Z","timestamp":1790692337000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":11,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,29]]},"published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1136\/bcr-2026-274731"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274731","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]}}}