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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