Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation.
OBJECTIVE
Report of delayed significant coagulopathy, thrombocytopenia, and bleeding after Crotaline envenomation.


METHODS
Recurrent coagulopathy and thrombocytopenia have been described after treatment of Crotaline envenomation with Crotalidae polyvalent immune Fab (CroFab). Until now, there have been no reports of significant spontaneous bleeding despite these abnormalities.


RESULTS
Crotalidae polyvalent immune Fab has a relatively short half-life compared with previous antivenoms used to treat snake bite. This shorter half-life allows for recurrence of venom effects. Therefore, patients with Crotaline envenomation should undergo close monitoring for recurrence of coagulopathy or thrombocytopenia after treatment with CroFab.


CONCLUSIONS
If coagulopathy or thrombocytopenia recurs, retreatment with CroFab should be considered to prevent significant bleeding.
O'Brien
Nicole F
NF
Department of Critical Care, Rady Children's Hospital, San Diego, CA 32123, USA.
DeMott
Megan C
MC
Suchard
Jeffrey R
JR
Clark
Richard F
RF
Peterson
Bradley M
BM
D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000209:etiology*; D002675:Child, Preschool; D003435:Crotalid Venoms / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D055502:Secondary Prevention; D012909:Snake Bites / Q000150:complications* / Q000188:drug therapy; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors; D017819:Viperidae
D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments