Related Experiment Video
Updated: Dec 16, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Utilization of thromboelastograms in management of Crotalus adamanteus envenomation
William F Rushton1,2, Jessica V Rivera1, Julie Brown3
1Office of Medical Toxicology, Department of Emergency Medicine, University of Alabama-Birmingham, Birmingham, AL, USA.
Insights
Thromboelastography (TEG) effectively monitored coagulopathy in a pit viper envenomation case. This real-time analysis guided antivenin therapy better than traditional methods, improving patient outcomes.
Area of Science:
- Toxicology
- Emergency Medicine
- Hematology
Background:
- Pit viper (Crotalinae) envenomations present diagnostic and treatment challenges in emergency departments.
- Ambiguity in species identification and antivenin treatment timing complicates management.
- Venom-induced consumptive coagulopathy requires effective real-time monitoring.
Observation:
- A 61-year-old snake handler experienced severe coagulopathy after an eastern diamondback rattlesnake (Crotalus adamanteus) bite.
- Initial antivenin (FabAV) provided transient improvement, with coagulopathy recurring over 10 days.
- Serial thromboelastography (TEG) was used to monitor the patient's condition.
Findings:
- TEG identified and corroborated fibrinolysis, a key indicator of coagulopathy.
- TEG predicted clot formation earlier than routine coagulation studies.
- TEG demonstrated improvements in clotting function preceding standard laboratory results.
Implications:
- Thromboelastography (TEG) offers a valuable real-time tool for managing pit viper envenomations.
- TEG can guide antivenin therapy more effectively than traditional coagulation parameters.
- Early detection of fibrinolysis and clotting function via TEG improves patient care in complex envenomations.
Background:
Crotalinae (pit viper) envenomations are frequently encountered in North American emergency departments. Cases can be complicated by ambiguity in initial species identification as well as timing and duration of current antivenin treatment. Recently, thromboelastography (TEG) has emerged as an enhanced real-time monitoring parameter for snake envenomations that may aid in management of venom-induced consumptive coagulopathy.
Case:
A 61-year-old snake handler presented with severe coagulopathy and hypofibrinogenemia following envenomation from her pet eastern diamondback rattlesnake (Crotalus adamanteus). Her coagulopathy transiently improved with Crotalidae Polyvalent Immune Fab (Ovine) (FabAV) but would repeatedly rebound following cessation of antivenin over the next 10 days. Serial TEGs were successfully utilized to identify and corroborate fibrinolysis while predicting clot formation prior to routine coagulation studies.
Discussion:
Traditional coagulation parameters have not always been ideal when treating severe coagulopathy from pit viper envenomations and may not identify active fibrinolysis for several hours. In this case of C. adamanteus envenomation, TEG proved to be useful in demonstrating improvements in clotting function prior to standard laboratory measures, which further guided antivenin therapy.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:30Venous Thrombosis IV: Nursing Management
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...