• Vance G Nielsen, Benjamin D Garol, Eric A Zelman, and Marlon A Guerrero.
• Department of Anesthesiology bDepartment of Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA. vgnielsen@email.arizona.edu
• Blood Coagul. Fibrinolysis. 2013 Sep 1;24(6):663-5.

AbstractThyroid cancers can cause significant regional thrombotic morbidity and mortality. Of interest, thyroid cancer cell lines can have upregulation of the carbon monoxide-producing enzyme, hemeoxygenase-1. Carbon monoxide has been demonstrated to markedly enhance plasmatic coagulation in vitro and in vivo via enhancement of fibrinogen's substrate properties by binding to a fibrinogen-associated heme group(s). We present a patient undergoing removal of a malignant thyroid tumour who was serendipitously found to have abnormally increased carboxyhaemoglobin concentration (2.4%) and plasmatic hypercoagulability with a carbon monoxide-mediated clot strength as determined by a thrombelastographic method. This initial observation serves as a rationale to further investigate the role played by hemeoxygenase-1 upregulation in the setting of cancers associated with increased endogenous carbon monoxide production.

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