• Michael Levine, Hannah Spungen, and Anthony F Pizon.
• Department of Emergency Medicine, University of California, Los Angeles, California. Electronic address: michaellevine@mednet.ucla.edu.
• Ann Emerg Med. 2022 Dec 1; 80 (6): 525527525-527.

AbstractRattlesnake envenomation can result in significant cutaneous and hematologic toxicity. While Cotalidae polyvalent immune Fab (ovine) antivenom (marketed as CroFab) was available for years, it is associated with increased late hematologic toxicity compared with its predecessor. Consequently, Crotalidae Immune F(ab')2 equine antivenom [marketed as Anavip; F(ab')2AV] has been recently become available. In this paper, we report a case of a 53 year-old man envenomated on his right hand by a Southern Pacific rattlesnake (Crotalus helleri). Edema was present, and his initial platelets were not able to be measured, prompting the administration of 10 vials of F(ab')2AV. Ultimately, he received a total of 52 vials of antivenom, before his platelets peaked at 102,000/μL, 56 hours post envenomation. Within hours, his platelets began to fall again. Ultimately, his platelets reached a post-antivenom nadir of 65,000/μL. He was observed closely as an outpatient without additional antivenom, and ultimately had normalization of his platelets (211,000/μL) 20 days post envenomation. This case is one of the first cases demonstrating an inability to achieve control of the hematologic toxicity following Southern Pacific rattlesnake envenomation after treatment with F(ab')2AV.Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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