Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation.

OBJECTIVES: Report of delayed significant coagulopathy, thrombocytopenia, and bleeding after Crotaline envenomation.

METHODS: Recurrent coagulopathy and thrombocytopenia have been described after treatment of Crotaline envenomation with Crotalidae polyvalent immune Fab (CroFab). Until now, there have been no reports of significant spontaneous bleeding despite these abnormalities.

RESULTS: Crotalidae polyvalent immune Fab has a relatively short half-life compared with previous antivenoms used to treat snake bite. This shorter half-life allows for recurrence of venom effects. Therefore, patients with Crotaline envenomation should undergo close monitoring for recurrence of coagulopathy or thrombocytopenia after treatment with CroFab.

CONCLUSIONS: If coagulopathy or thrombocytopenia recurs, retreatment with CroFab should be considered to prevent significant bleeding.