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AlbayCorc t1_irs0led wrote

Hello Mr Hunt, I am curious what you think of this real condition: 35 years old male, has thrombosis in left popliteal artery, with total occlusion, extending down for 11cm. Smoked for 9 yrs, alcohol used, condition worsened after heavy depression and pandemic period but started long before (at least a year before pandemic). Was failed to diagnose in Europe, finally diagnosed at 4th of August 2022 in turkey. Never had covid during this time.

He has MTHFR hetorozygot and 4G/5G allelles from thrombophilia genetic tests. Do you think it may be buergers? The hematology docent thinks the mutations could be contributing at least, He also has mild hyperhomocysteinemia. I repeat another user's question here, is homocysteine testing also unnecessary? Could it be harmful to try to lower homocysteine with b vitamins and folic acid?

Sorry that's too many questions in one comment, it's not often to find a hematology professor with time to answer! All my questions are out of curiosity rather than trying to prove otherwise. Thank you for your time! Have a nice day!

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WorldThrombosisDay t1_irs2dja wrote

I can't talk about a specific patient because I don't have enough information and they have to be my own specific patient, otherwise I could lose my ability to practice! However, I can say that if I saw a young man with a popliteal artery thrombosis, I would not think it was Buergers because Buergers affects the small tiny arteries first. And therefore it wouldn't present usually just in one leg - it would affect the fingers and toes first.

Secondly, the thrombophilia I would be looking for would be antiphospholipid syndrome, which is notorious for affecting young people. Lastly, raised homocysteine levels do not cause thrombosis in blood vessels such as the popliteal artery, neither do the 4G/5G polymorphism.

If you have mildly raised homocysteine levels, it's also because you're not eating enough folic acid. Folic acid is a vitamin in present in green foods, so I always encourage patients to follow the old wives tale of "eat your greens."

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