Biphasic rattlesnake venom-induced thrombocytopenia

Thrombocytopenia is a common occurrence in moderate to severe crotaline envenomation. The exact mechanism by which rattlesnake venom leads to thrombocytopenia is unclear, but aggressive treatment with crotaline-specific antivenom often leads to resolution of this disorder. Crotalinae Polyvalent Immu...

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Bibliographic Details
Published in:The Journal of emergency medicine 2003-04, Vol.24 (3), p.289-293
Main Authors: Offerman, Steven R, Barry, J.David, Schneir, Aaron, Clark, Richard F
Format: Article
Language:English
Subjects:
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antivenins
Biological and medical sciences
Crotalid Venoms - adverse effects
crotaline
envenomation
Humans
Immunoglobulin Fab Fragments
Immunoglobulin Fragments - therapeutic use
Intensive care medicine
Male
Medical sciences
Miscellaneous
rattlesnake
Snake Bites - complications
Snake Bites - drug therapy
thrombocytopenia
Thrombocytopenia - chemically induced
Thrombocytopenia - etiology
Treatment Failure
venom
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Summary:Thrombocytopenia is a common occurrence in moderate to severe crotaline envenomation. The exact mechanism by which rattlesnake venom leads to thrombocytopenia is unclear, but aggressive treatment with crotaline-specific antivenom often leads to resolution of this disorder. Crotalinae Polyvalent Immune Fab (CroFab TM, Protherics Inc., Nashville, TN) (crotaline Fab) is now available for the treatment of symptomatic rattlesnake envenomation. Although recurrence of thrombocytopenia has been reported in patients after envenomation treated with crotaline Fab, cases refractory to this therapy have not been described. We report a case of severe crotaline envenomation that appears to have exhibited two separate episodes of thrombocytopenia, only one of which responded to antivenom. The second, later phase was refractory to both crotaline Fab as well as traditional Antivenin (Crotalinae) Polyvalent (Wyeth-Ayerst Pharmaceuticals, Philadelphia, PA) (ACP). By reviewing the literature regarding venom-induced thrombocytopenia, we attempt to explain this “biphasic” phenomenon and the inability of crotaline Fab to reverse this toxic effect.
ISSN:0736-4679
2352-5029
DOI:10.1016/S0736-4679(02)00763-1