• Abby M Bailey, Stephanie Justice, George A Davis, and Kyle Weant.
• Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, H110, Lexington, KY 40356, United States. Electronic address: ammyna3@uky.edu.
• Am J Emerg Med. 2017 Jul 1; 35 (7): 1038.e1-1038.e2.

AbstractNorth 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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