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Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom.
Toxicon. 2011 Jan; 57(1):53-9.T

Abstract

BACKGROUND

North American rattlesnake envenomations commonly produce defibrination, coagulopathy and/or thrombocytopenia, which may be reversed following treatment with Crotalidae Polyvalent Immune Fab Ovine (FabAV). Despite initial resolution with FabAV, late onset or recurrence of venom-induced hematologic effects may occur. Time at which onset of late hematotoxicity may first be detected is unknown. The purpose of this study was to identify the incidence and time of onset of recurrent or new late hypofibrinogenemia, coagulopathy, or thrombocytopenia in a cohort of rattlesnake envenomation patients seen in outpatient follow-up after treatment with FabAV, and to report hematologic outcomes in these patients.

METHODS

Review of 66 charts of patients with rattlesnake envenomation who were treated with FabAV, and subsequently had outpatient follow-up evaluation at least 48 h after last FabAV, was performed. Demographic information, rattlesnake and bite characteristics, dose and timing of antivenom administration, adverse events, in-patient laboratory values, length of hospital stay, and follow-up laboratory values were collected. The primary outcome parameters were recurrent or delayed onset coagulopathy, hypofibrinogenemia, or thrombocytopenia identified no sooner than 48 h after last dose of FabAV.

RESULTS

Prior to control of the envenomation with FabAV, 42 patients (63.6%) experienced hematologic toxicity. At follow-up, 21 patients (32%) were found to have late coagulopathy, hypofibrinogenemia, or thrombocytopenia. Of twenty-three patients (35%) with more than one follow-up visit, fifteen had normal laboratory findings at the first follow-up visit. Five of these 15 patients (8% of total study group; 33% of this subgroup) with normal hematologic studies at first follow-up exhibited late hematologic toxicity at second follow-up. Severe late hematologic toxicity developed in five of 66 (8%) patients. One patient was retreated with FabAV for late severe thrombocytopenia.

CONCLUSION

Recurrent and delayed onset of hematologic toxicity in rattlesnake envenomation victims treated with FabAV is common. Follow-up more than three days after treatment is necessary to detect all cases of late hematologic toxicity.

Authors+Show Affiliations

Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ, United States. Michelle.ruha@bannerhealth.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20920516

Citation

Ruha, Anne-Michelle, et al. "Late Hematologic Toxicity Following Treatment of Rattlesnake Envenomation With Crotalidae Polyvalent Immune Fab Antivenom." Toxicon : Official Journal of the International Society On Toxinology, vol. 57, no. 1, 2011, pp. 53-9.
Ruha AM, Curry SC, Albrecht C, et al. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57(1):53-9.
Ruha, A. M., Curry, S. C., Albrecht, C., Riley, B., & Pizon, A. (2011). Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon : Official Journal of the International Society On Toxinology, 57(1), 53-9. https://doi.org/10.1016/j.toxicon.2010.09.014
Ruha AM, et al. Late Hematologic Toxicity Following Treatment of Rattlesnake Envenomation With Crotalidae Polyvalent Immune Fab Antivenom. Toxicon. 2011;57(1):53-9. PubMed PMID: 20920516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. AU - Ruha,Anne-Michelle, AU - Curry,Steven C, AU - Albrecht,Clay, AU - Riley,Brad, AU - Pizon,Anthony, Y1 - 2010/10/08/ PY - 2010/07/01/received PY - 2010/08/27/revised PY - 2010/09/25/accepted PY - 2010/10/6/entrez PY - 2010/10/6/pubmed PY - 2011/4/8/medline SP - 53 EP - 9 JF - Toxicon : official journal of the International Society on Toxinology JO - Toxicon VL - 57 IS - 1 N2 - BACKGROUND: North American rattlesnake envenomations commonly produce defibrination, coagulopathy and/or thrombocytopenia, which may be reversed following treatment with Crotalidae Polyvalent Immune Fab Ovine (FabAV). Despite initial resolution with FabAV, late onset or recurrence of venom-induced hematologic effects may occur. Time at which onset of late hematotoxicity may first be detected is unknown. The purpose of this study was to identify the incidence and time of onset of recurrent or new late hypofibrinogenemia, coagulopathy, or thrombocytopenia in a cohort of rattlesnake envenomation patients seen in outpatient follow-up after treatment with FabAV, and to report hematologic outcomes in these patients. METHODS: Review of 66 charts of patients with rattlesnake envenomation who were treated with FabAV, and subsequently had outpatient follow-up evaluation at least 48 h after last FabAV, was performed. Demographic information, rattlesnake and bite characteristics, dose and timing of antivenom administration, adverse events, in-patient laboratory values, length of hospital stay, and follow-up laboratory values were collected. The primary outcome parameters were recurrent or delayed onset coagulopathy, hypofibrinogenemia, or thrombocytopenia identified no sooner than 48 h after last dose of FabAV. RESULTS: Prior to control of the envenomation with FabAV, 42 patients (63.6%) experienced hematologic toxicity. At follow-up, 21 patients (32%) were found to have late coagulopathy, hypofibrinogenemia, or thrombocytopenia. Of twenty-three patients (35%) with more than one follow-up visit, fifteen had normal laboratory findings at the first follow-up visit. Five of these 15 patients (8% of total study group; 33% of this subgroup) with normal hematologic studies at first follow-up exhibited late hematologic toxicity at second follow-up. Severe late hematologic toxicity developed in five of 66 (8%) patients. One patient was retreated with FabAV for late severe thrombocytopenia. CONCLUSION: Recurrent and delayed onset of hematologic toxicity in rattlesnake envenomation victims treated with FabAV is common. Follow-up more than three days after treatment is necessary to detect all cases of late hematologic toxicity. SN - 1879-3150 UR - https://www.unboundmedicine.com/medline/citation/20920516/Late_hematologic_toxicity_following_treatment_of_rattlesnake_envenomation_with_crotalidae_polyvalent_immune_Fab_antivenom_ DB - PRIME DP - Unbound Medicine ER -