A coagulopathic dilemma: snakes or genes

A 66-year-old man presented to a small hospital in south-west Queensland, Australia, in March, 2013, after a snakebite to his index finger. Brown and black snakes are the two main types of snake that cause bites in the region. The patient had a history of haemochromatosis, and recent skin grafts after removal of skin cancers. He took no regular medications. He had no local or systemic symptoms. Bloods were taken 45 min after the bite and he was transferred to a larger hospital. Initial international normalised ratio (INR) and fibrinogen were normal (figure), qualitative D-dimer was positive, but the activated partial thromboplastin time (aPTT) was unrecordable. In an asymptomatic patient with normal INR, the D-dimer was attributed to his recent skin grafts, and the raised aPTT was interpreted as a sampling error.