Extensive Hematoma in a Patient with Hereditary Hypersegmentation of Neutrophils

Hypercoagulable states are a group of conditions associated with anenhanced tendency toward blood clotting. Although usual clinicalmanifestations of hypercoagulable states are thrombotic events such as deepvenous thrombosis, hematoma can also occur as a result ofhypercoagulability in some patients. Several inherited or acquiredconditions may lead to hypercoagulable states. Some of themincludemyeloproliferative syndromes, over activity of coagulation factorsand methyl tetrahydrofolate reductase (MTHFR) polymorphisms. MTHFRis required for converting the amino acid homocysteine to methionine.Another significant role of an aptly functioning MTHFR enzyme is nucleicacid biosynthesis. Therefore MTHFR polymorphisms are expected to beassociated with hypersegmentation of neutrophils because of a defect inDNA metabolism. Neutrophil hypersegmentation is one of the mostsensitive hematological features of cobalamin or folate deficiency withnormal serum vitamin B12-folic acid and iron levels. Hypersegmentation ofneutrophils and hematoma or both of them suspected to be due to genevariations of MTHFR.Here we report a 37-years old female who simultaneously affected byhereditary hypersegmentation and extensive hematoma. Laboratory analysisrevealed normal serum vitamin B12, folic acid and iron levels. Routine andspecific coagulation tests were normal in except of factor VIIIc that washigh. Results of complete blood cell count (CBC) test were normal.Although this is just an idea, but simultaneous presentations of these twoconditions can have a common origin.

کلیدواژه ها:

Hematoma ، Neutrophil hypersegmentation ، Hypercoagulability