Blood group discrepancy in snakebite management: Unravelling the culprit

Abstract

Snakebite envenomation is a global health concern that can result in significant morbidity and mortality. Accurate blood grouping and cross-matching are critical components of effective management, particularly when administering antivenom therapy. We present a case of a 54-year-old female who was admitted with a snakebite (Bunggrus caeruleus) and initially found to have B Rh(D) positive blood group. However, a discrepancy in the patient's blood grouping was identified on the third day of hospitalization, with the reverse grouping indicating group AB. Investigation revealed that the patient had received neuro polyvalent snake antivenom, which likely caused the discrepancy. The presence of A-like substances in equine-derived ASV (anti-snake venom) can effectively neutralize anti-A antibodies, leading to erroneous blood grouping results. This case highlights the potential for ASV to cause discrepancies in blood grouping and emphasizes the importance of laboratory personnel and clinicians being aware of this possibility. It also underscores the need for blood grouping discrepancy resolution and cross-matching with the correct unit. Healthcare professionals should consider advising patients who are to receive ASV to give blood grouping samples before ASV infusion and carry cards indicating their true blood types. Overall, a greater awareness of the potential for ASV to cause blood grouping discrepancies can improve patient outcomes in the management of snakebite.