48 year old female. Found to have anemia and splenomegaly on routine examination by local physician. Referred to University Hematology Clinic. Physical Exam Spleen palpable to the level of the umbilicus. Liver palpable 3 cm. below right costal margin. The rest of the exam was within normal limits. Share your views regarding the case


Clinical Presentation - Anaemia and Hepatosplenomegaly Peripheral Blood Smear -image 3 RBCs show mild anisopoikilocytosis comprising of predominantly normocytes , few microcytes , elliptocytes , tear drop cells ( dacrocytes). A nucleated RBC noted along with a polychromatophilic RBC. WBC series Not in images Platelets - Appear to be adequate in number.Platelet Pleomorphism noted - Giant platelet form , bizarre platelet forms No haemoparasite as per the images Image 2 - CBC Hb 10.4 Anaemia NRBCs 5 per 100 WBCs DLC shows shift left - meta plus myelo -4+2 Platelets just adequate CBC plus PBF findings - Leukoerythroblastic blood picture Image 1 Bone Marrow Aspirate - Diluted ( ? due to fibrosis) Immature Megakaryocytes noted Differential Percentage Erythroblasts 47 percent plus Myeloblasts 1 percent 48 percent in 500 cells so approximately 10 percent in 100 differential count Biopsy - Hypercellular Marrow spaces with Marked Reticulin and increased megakaryocytes Impression Overall Findings - Clinical,PBF , CBC , Bone Marrow and Biopsy-Suggesting diagnosis of Fibrotic Stage of Myelofibrosis With 10 percent blasts in the marrow marked Reticulin and a Leucoerythroblastic blood picture on PBF Advice Mutational Analysis 1. JAK2V627F Positive in 50 to 60 percent cases of Myelofibrosis 2.BCR ABL will be negative 3. CALR and MPL Thanku Mam
You seem to be a walking encyclopedia Dr Mohit..really impressed by your approach,description n knowledge.. Just out of curiosity..where did you do your MD n where do you practice...

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Pre leukemic condition or non lymphatic leukemia or chronic myeloid leukemia as micromegakaryocytes present in marrow
Leukoerythroblastic Blood picture suggestive of myelofibrosis secondary to myelodysplasia ( considering ineffective haematopoiesis, the presence of micromegakaryocytes in Bone marrow and dimorphic red cell population on the smear examination).
In CBC looks like leukoerythroblastic reaction.... Here myeloproliferative disorder like primary myelofibrosis seems most likely... Molecular genetic study needed
Peripheral smear shows presence of normocytes,elliptocytes and few tear drop cells.there is also presence of nucleated rbcs.
Acknowledge us with your final diagnosis mam
Mam please update the diagnosis Thanku
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