28 November 2017 (Tuesday) - Myelofibrosis

This appeared on one of the Facebook groups I follow:

This patient has been a regular of ours from a haematology clinic for the last year for regular monitoring of their myelofibrosis.
While the patients' haemoglobin and platelet counts have remained normal and steady, they have become iron deficient, and their white cell count has progressively climbed from normal to now 45 x 10^9/L.
The film shows a leucoerythroblastic picture with both immature myeloid cells (including ~3% blasts) and occasional nucleated red cells. Interestingly there are only occasional teardrop cells, which are often a prominent feature of MF.
Originally called "Idiopathic Myelofibrosis" since the cause was unknown, it is known now to be a myeloproliferative neoplasm particular of megakaryocytes. You can see in these images that while the platelet count is normal, there is platelet anisocytosis with large and giant platelets, and occasional megakaryocyte fragments (in my laboratory though, we usually don't make the distinction between giant platelets and megakaryocyte fragments).
I have added two images of bone marrow from this patient from February this year - one in H&E and the other reticulin. The marrow was a dry tap, but touch preps showed architectural distorsion and fibrosis, and marked increase in reticulin. Since it has been 9 months since this marrow, there would likely be disease progression.
Hope you enjoy these images

The images are available by clicking here

As always, a case study is invaluable. Realistically I seem to get 90+% of them via Facebook these days

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