Bailey Abby M, Justice Stephanie, Davis George A, Weant Kyle
Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, H110, Lexington, KY 40356, United States.
Department of Pharmacy, St. Claire Regional Medical Center, 222 Medical Circle, Morehead, KY 40351, United States.
Am J Emerg Med. 2017 Jul;35(7):1038.e1-1038.e2. doi: 10.1016/j.ajem.2017.02.045. Epub 2017 Feb 27.
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.
北美响尾蛇咬伤已知会导致凝血功能障碍和血小板减少。然而，医学文献中对延迟性血液毒性（咬伤后不到七天）的发生情况描述甚少。虽然已有文献记载咬伤后血液紊乱会复发，但通常并无临床上显著的出血情况。尽管通常建议治疗延迟性凝血功能障碍，但抗蛇毒血清（CroFab®）治疗这种情况的有效性仍存在疑问，值得进一步研究和探索。我们描述了一名19岁男性的病例，他在一次教堂礼拜活动中被响尾蛇咬伤后前来就诊，接受了48小时的抗蛇毒血清治疗后出院回家，但四天后因严重血小板减少、凝血功能障碍和临床上显著的出血再次返回。
