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Recurrent, persistent, or late, new-onset hematologic abnormalities in Crotaline snakebite.

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Rattlesnake bites can cause late-onset bleeding issues. Normal blood tests within 48 hours and no significant platelet increase after antivenom predict no late hematologic effects.

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Area of Science:

  • Toxicology
  • Hematology
  • Emergency Medicine

Background:

  • Rattlesnake envenomation can lead to delayed hematologic abnormalities in patients treated with antivenom.
  • Predictive indicators for these late-onset effects are currently lacking.

Purpose of the Study:

  • To identify reliable indicators for predicting late hematologic abnormalities after rattlesnake envenomation in patients receiving Fab antivenom.
  • To determine the sensitivity, specificity, PPV, and NPV of various hematologic parameters for predicting late effects.

Main Methods:

  • Retrospective observational case series of 376 rattlesnake bite records from two US poison centers.
  • Sixty cases met inclusion criteria for analysis of hematologic parameters (D-dimer, fibrinogen, platelets, INR, PTT).
  • Evaluation of parameters associated with late hematologic abnormalities (occurring ≥4 days post-envenomation).

Main Results:

  • 18% of patients developed late hematologic abnormalities (≥4 days post-envenomation).
  • Late hypofibrinogenemia and/or thrombocytopenia were linked to early D-dimer elevation and/or platelet rise post-antivenom.
  • Normal hematologic parameters within 48 hours and <20% platelet rise within 4 hours post-antivenom had 100% NPV for late effects.

Conclusions:

  • Early hypofibrinogenemia, positive D-dimer, thrombocytopenia, or a significant platelet increase post-antivenom suggest a high likelihood of late hematologic effects.
  • Absence of these early indicators predicts no development of late hematologic complications.