Intravascular hemolysis associated with North American crotalid envenomation

Case Report: This is a case of severe intravascular hemolysis, without significant coagulopathy, following envenomation by a North American crotalid. A MEDLINE search from 1966-1997, and a review of older literature, revealed no similar cases. A 4-year-old girl was envenomated in her right foot by a 2.5 foot-long rattlesnake whose description matched that of the Hopi rattlesnake (Crotalus viridis nuntius). The snake was not captured. Her initial hematocrit was 45%. In spite of treatment with antivenin and improvement in her lower extremity pain and swelling, her hematocrit decreased to 20.4%. Laboratory tests and clinical exam showed a Coombs positive hemolytic anemia without significant signs of coagulopathy.
INTRODUCTION Snake venoms are a well-known cause of coagulopathy and syndromes of disseminated intravascular coagulation (DIC).[1-12] As many as 40 % of people envenomated by North American crotalids suffer from [...]