Crotalidae polyvalent immune fab

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Crotalidae Polyvalent Immune Fab (Ovine) (CroFab) is a medical treatment used in the management of envenomations by North American crotalid snakes, which include rattlesnakes, copperheads, and cottonmouth/water moccasins. It is a type of antivenom that has been developed to neutralize the toxins of these snakes, thereby preventing or minimizing the complications associated with snake bites. This article provides an overview of its composition, indications, administration, and considerations.

Composition and Production[edit | edit source]

Crotalidae Polyvalent Immune Fab (Ovine) is produced by immunizing sheep with the venoms of four different species of snakes: the Eastern diamondback rattlesnake (Crotalus adamanteus), the Western diamondback rattlesnake (Crotalus atrox), the Mojave rattlesnake (Crotalus scutulatus), and the cottonmouth (Agkistrodon piscivorus). The sheep then produce antibodies against these venoms, which are purified to create the Fab fragments. These fragments are what constitute the active ingredient in CroFab, providing the ability to neutralize the venom.

Indications[edit | edit source]

CroFab is indicated for the management of adult and pediatric patients with North American crotalid envenomation. The severity of the snake bite and the symptoms presented by the patient determine the necessity and the amount of CroFab to be administered. It is used to halt the progression of systemic symptoms, reduce the risk of severe hematologic and cardiovascular complications, and minimize local tissue damage.

Administration[edit | edit source]

The administration of CroFab should be initiated as soon as possible after the snake bite in patients who show signs of systemic or severe local envenomation. The initial dose and subsequent dosing are determined based on the clinical response of the patient. Continuous monitoring of the patient is essential to adjust the treatment as needed. CroFab is administered intravenously, and its use requires specific medical expertise to manage potential allergic reactions and other complications.

Considerations and Side Effects[edit | edit source]

While CroFab is effective in treating snake bites, it is not without risks. Patients may experience allergic reactions, including anaphylaxis. Therefore, it is crucial to have emergency resuscitation equipment and medication readily available when administering this antivenom. Other potential side effects include rash, pruritus, nausea, and back pain. The risk of serum sickness, a delayed immune response to the foreign proteins in the antivenom, is also present and requires close follow-up care.

Conclusion[edit | edit source]

Crotalidae Polyvalent Immune Fab (Ovine) represents a significant advancement in the treatment of venomous snake bites from North American crotalids. Its development and use have improved the prognosis for many patients experiencing envenomations. However, its administration requires careful consideration of the potential risks and benefits, highlighting the importance of specialized training for healthcare providers who manage snake bite cases.

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Contributors: Prab R. Tumpati, MD