Hematologic toxicity (coagulopathy/bleeding) can occur with pit viper envenomation. Copperhead is the most commonly implicated pit viper envenomation in the U.S. However, the prevalence of hematologic toxicity from copperhead envenomation is variable, possibly due to regional variation in venom potency and species misidentification.
An observation study was performing using multi-center (Virginia Commonweath university, University of Virginia Medical Center and Eastern Virginia Medical medical center) electronic hospital/medical records (Jan 1, 2006 to Dec 31, 2016) of suspected copperhead bites. Authors state that copperhead snakes are "nearly exclusively endemic" to the VCU and UVA medical center region.
Results:
388 patients were identified but 244 met inclusion/exclusion criteria.
Mean age: 34 years
Male: 59%
Antivenom administration: 76%
No bleeding was reported.
Hematologic toxicity: 14%
Elevated PT: 10.0%
Elevated PTT: 3.9%
Thrombocytopenia: 1.2%
Hypofibrinogenemia: 0.7%
Conclusion
In a small sample of copperhead envenomation in Virginia, “subtle” hematologic abnormalities were observed but clinically significant hematologic toxicity was not observed (i.e. bleeding)
References
Wills BK et al. Prevalence of hematologic toxicity from copperhead envenomation: an observational study. Clin Toxicol. 2019. DOI: 10.1080/15563650.2019.1644346
