Extensive Hematoma in a Patient with Hereditary Hypersegmentation of Neutrophils

Hypercoagulable states are a group of conditions associated with an enhanced tendency toward blood clotting. Although usual clinical manifestations of hypercoagulable states are thrombotic events such as deep venous thrombosis, hematoma can also occur as a result of hypercoagulability in some patients. Several inherited or acquired conditions may lead to hypercoagulable states. Some of them includemyeloproliferative syndromes, over activity of coagulation factors and methyl tetrahydrofolate reductase (MTHFR) polymorphisms. MTHFR is required for converting the amino acid homocysteine to methionine. Another significant role of an aptly functioning MTHFR enzyme is nucleic acid biosynthesis. Therefore MTHFR polymorphisms are expected to be associated with hypersegmentation of neutrophils because of a defect in DNA metabolism. Neutrophil hypersegmentation is one of the most sensitive hematological features of cobalamin or folate deficiency with normal serum vitamin B12-folic acid and iron levels. Hypersegmentation of neutrophils and hematoma or both of them suspected to be due to gene variations of MTHFR. Here we report a 37-years old female who simultaneously affected by hereditary hypersegmentation and extensive hematoma. Laboratory analysis revealed normal serum vitamin B12, folic acid and iron levels. Routine and specific coagulation tests were normal in except of factor VIIIc that was high. Results of complete blood cell count (CBC) test were normal. Although this is just an idea, but simultaneous presentations of these two conditions can have a common origin