title: Delayed hematologic toxicity following rattlesnake envenomation unresponsive to crotalidae polyvalent antivenom.
abstract: North American rattlesnake envenomations are known to produce coagulopathies and thrombocytopenia. However, the occurrence of delayed hematologic toxicity (less than seven days after envenomation) is poorly characterized in the medical literature. While the recurrence of hematologic derangements has been documented following envenomation, it is usually in the absence of clinically significant bleeding. Although commonly recommended to treat delayed coagulopathies, the effectiveness of crotalidae polyvalent immune Fab ovine (CroFab®) in managing this condition remains in question and warrants further investigation and exploration. We describe the case of a 19-year-old male who presented following rattlesnake envenomation at a church service who was treated with antivenin for 48 h and discharged home only to return four days later with profound thrombocytopenia, coagulopathy, and clinically significant bleeding.
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, H110, Lexington, KY 40356, United States. Electronic address: ammyna3@uky.edu.
authors.forename: Abby M
authors.initials: AM
authors.lastname: Bailey
authors.affiliation: Department of Pharmacy, St. Claire Regional Medical Center, 222 Medical Circle, Morehead, KY 40351, United States. Electronic address: stephanie.justice@st-claire.org.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Justice
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, H110, Lexington, KY 40356, United States.
authors.forename: George A
authors.initials: GA
authors.lastname: Davis
authors.affiliation: Department of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, United States. Electronic address: weant@musc.edu.
authors.forename: Kyle
authors.initials: K
authors.lastname: Weant
mesh_terms: D000818:Animals; D000997:Antivenins / Q000009:adverse effects / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors; D017839:Crotalus; D004334:Drug Administration Schedule; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000627:therapeutic use*; D008297:Male; D012008:Recurrence; D012909:Snake Bites / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments
keywords: Crotalidae polyvalent immune Fab; Delayed coagulopathy; Envenomation; Thrombocytopenia