Rotational thromboelastometry guided transfusion in venom-induced consumptive coagulopathy following a haemotoxic snakebite

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’s 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.