does not activate platelets, the production of fibrin strands can result in a reduced platelet count, as well as the hemolysis of red blood cells (see article on MAHA). Even with this defibrination, however, clinically significant bleeding is uncommon. Nevertheless, the venom does exhibit high hemorrhagic activity. It also contains a low-molecular-weight basic peptide that impedes neuromuscular transmission and can in theory lead to cardiac failure. This peptide is similar to crotamine from C. durrisus terrificus, and makes up 2–8% of the protein found in the venom. In general, the venom can be described as highly necrotizing, mildly proteolytic and containing a large phosphodiesterase fraction. It stimulates the release of bradykinin that can result in severe pain, as well as profound, transient hypotension. Klauber described one case in which the symptoms included instant pain "like two hot hypodermic needles", spontaneous bleeding from the bite site, intense internal pain, bleeding from the mouth, hypotension, a weak pulse, swelling and discoloration of the affected limb, and associated severe pain. The symptoms were further described as strongly hemolytic and hemorrhagic. CroFab, ANAVIP, and Wyeth's ACP are effective antivenins against bites from this species, although massive doses may be needed to manage severe cases of envenomation. Generally, ACP is very effective at countering the defibrination syndrome that is often seen, but may do little for low platelet counts. Wyeth's ACP is no longer being manufactured. References Further reading Brattstrom BH (1954). "The fossil pit-vipers (Reptilia: Crotalidae) of North America". Transactions of the San Diego Society of Natural History 12: 31-46 [35]. Brickell J (1805). "Miscellaneous chemical and medical facts, observations and conjectures". Philadelphia Med. and Phys. Jour. 2: 164 [164]. Conant R, Bridges W (1939). What Snake Is That?: A Field Guide to the Snakes of the United States East of the Rocky Mountains. ( With 108 drawings by Edmond Malnate). New York and London: D. Appleton-Century Company. Frontispiece map + viii + 163 pp. + Plates A-C, 1-32. (Crotalus adamanteus, pp. 145–147 + Plate 30, Figure 86). Cope ED (1867). "On the Reptilia and Batrachia of the Sonoran province of the Nearctic region". Proceedings of the Academy of Natural Sciences of Philadelphia 18: 300-314 [307]. Cope ED (1875). Check-list of North American Batrachia and Reptiles with a systematic list of higher groups, and an essay on geographical distribution based on specimens contained in the United States National Museum. Washington, District of Columbia: Government