Pit viper envenoming commonly causes venom-induced consumption coagulopathy with hypofibrinogenaemia. However, isolated thrombocytopenia without fibrinogen depletion is less recognised and may alter transfusion strategy. We report a confirmed Ovophis tonkinensis bite from northern Vietnam presenting with severe isolated thrombocytopenia and local necrosis. The case highlights the importance of serial platelet monitoring, awareness of fibrinogen availability and appropriate timing of antivenom and platelet support in resource-limited tropical settings.
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