Unpredicted late-, new-onset thrombocytopenia and hypofibrinogenemia in Fab antivenom-treated rattlesnake envenomation

S A Seifert; D N Mascarenas; L Fullerton; B J Warrick; S C Smolinske

doi:10.1016/j.toxicon.2020.05.026

Unpredicted late-, new-onset thrombocytopenia and hypofibrinogenemia in Fab antivenom-treated rattlesnake envenomation

Toxicon. 2020 Sep:184:55-56. doi: 10.1016/j.toxicon.2020.05.026. Epub 2020 Jun 4.

Authors

S A Seifert¹, D N Mascarenas², L Fullerton², B J Warrick³, S C Smolinske⁴

Affiliations

¹ University of New Mexico Health Sciences Center, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Electronic address: [email protected].
² Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
³ University of New Mexico Health Sciences Center, Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
⁴ New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

PMID: 32505639
DOI: 10.1016/j.toxicon.2020.05.026

Abstract

The use of Fab antivenom (Crotalidae Polyvalent Immune Fab (Ovine) (CroFab); Boston Scientific) against North American Crotalidae envenomation is associated with the development of late- (≥4 days post-envenomation), new-onset of hematological abnormalities. Although attempts have been made to identify predictive indicators during the acute phase of an envenomation, of patients who are not at-risk of late-, new-onset of hematological abnormalities, there has been at least one prior report of a patient who developed thrombocytopenia that was unpredicted by current indicators. We add three cases of unpredicted, late-, new-onset of hematological abnormalities in patients with Fab-treated rattlesnake bite.

Keywords: Antivenom; Envenomation; Fab; Fibrinogen; Platelets; Rattlesnake; Recurrence.

MeSH terms

Afibrinogenemia / chemically induced
Animals
Antivenins / therapeutic use*
Crotalid Venoms
Crotalus
Humans
Immunoglobulin Fab Fragments
Sheep
Snake Bites / complications
Snake Bites / drug therapy*
Thrombocytopenia / chemically induced*

Substances

Antivenins
Crotalid Venoms
Crotalidae Polyvalent immune Fab
Immunoglobulin Fab Fragments