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Volume 17
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10.3390/toxins17120605
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Case Report

Venom-Induced Recurrent Thrombocytopenia: A Model of Intervention-Driven Platelet Modulation

by
Mojca Dobaja Borak
1,2,
Katarina Reberšek
3,
Tihana Kurtović
4,
Adrijana Leonardi
5,
Igor Križaj
5 and
Miran Brvar
1,6,*
1
Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
2
Doctoral School, Faculty of Medicine, University of Ljubljana,1000 Ljubljana, Slovenia
3
Department of Haematology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
4
Centre for Research and Knowledge Transfer in Biotechnology, University of Zagreb, 10000 Zagreb, Croatia
5
Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, 1000 Ljubljana, Slovenia
6
Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
*
Author to whom correspondence should be addressed.
Toxins 2025, 17(12), 605; https://doi.org/10.3390/toxins17120605
Submission received: 1 November 2025 / Revised: 12 December 2025 / Accepted: 13 December 2025 / Published: 17 December 2025
(This article belongs to the Section Animal Venoms)
Versions Notes

Abstract

We present the case of a Vipera ammodytes ammodytes (Vaa, nose-horned viper)-bitten patient with recurrent thrombocytopenia. A 53-year-old patient envenomated by Vaa experienced three episodes of venom-dependent thrombocytopenia (4, 57 and 11 × 109/L), all of which we managed with antivenom Fab fragments. Despite these three severe episodes of thrombocytopenia within 24 h, platelet function remained intact, as demonstrated by normal thromboelastometry and aggregometry (96, 126, and 150 U) results after antivenom was administered and the platelet count normalized. Furthermore, flow cytometry showed only 0.3–1.7% expression of P-selectin on platelets, indicating that platelets did not activate but remained functional during and after thrombocytopenia. We assessed platelet function using rotational thromboelastometry, which evaluates the overall kinetics of hemostasis, including clot formation and stability. We performed aggregometry, which also reflects platelet function, only when the platelet count was within the normal range. Flow cytometry quantified P-selectin expression as a key marker of platelet activation. This case demonstrates that a component of Vaa venom can repeatedly induce venom-dependent thrombocytopenia, which is reversible by intervention, while platelet function remains intact.
Keywords: Vipera ammodytes ammodytes; venom; thrombocytopenia; functional platelets; snaclec Vipera ammodytes ammodytes; venom; thrombocytopenia; functional platelets; snaclec

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MDPI and ACS Style

Dobaja Borak, M.; Reberšek, K.; Kurtović, T.; Leonardi, A.; Križaj, I.; Brvar, M. Venom-Induced Recurrent Thrombocytopenia: A Model of Intervention-Driven Platelet Modulation. Toxins 2025, 17, 605. https://doi.org/10.3390/toxins17120605

AMA Style

Dobaja Borak M, Reberšek K, Kurtović T, Leonardi A, Križaj I, Brvar M. Venom-Induced Recurrent Thrombocytopenia: A Model of Intervention-Driven Platelet Modulation. Toxins. 2025; 17(12):605. https://doi.org/10.3390/toxins17120605

Chicago/Turabian Style

Dobaja Borak, Mojca, Katarina Reberšek, Tihana Kurtović, Adrijana Leonardi, Igor Križaj, and Miran Brvar. 2025. "Venom-Induced Recurrent Thrombocytopenia: A Model of Intervention-Driven Platelet Modulation" Toxins 17, no. 12: 605. https://doi.org/10.3390/toxins17120605

APA Style

Dobaja Borak, M., Reberšek, K., Kurtović, T., Leonardi, A., Križaj, I., & Brvar, M. (2025). Venom-Induced Recurrent Thrombocytopenia: A Model of Intervention-Driven Platelet Modulation. Toxins, 17(12), 605. https://doi.org/10.3390/toxins17120605

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