Thursday, September 13, 2012


A 65 year old man presents with debilitating fatigue and some weight loss. On exam, you note hepatomegaly and splenomegaly. The spleen is pretty remarkable; you feel the inferior border at the pelvic brim and the right border past midline. His past medical history includes a DVT when he had a knee replacement. Otherwise, he's pretty healthy. However, labs are surprising. Hemoglobin is 9g/dL, WBC is 26,000/microL, platelets are 90,000/microL.

Peripheral blood smears are shown below:

You attempt to do a bone marrow aspiration but get a "dry tap." A bone marrow biopsy is shown below; the trichrome stain colors collagen blue.

Challenge: What's your diagnosis?

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1 comment:

Craig Chen said...


This is primary myelofibrosis. The first smear is leukoerythroblastic with nucleated red cells and immature white cells, consistent with marrow replacement (either by fibrosis or cancer). The second smear demonstrates teardrop cells. The bone marrow biopsy shows fibrosis.

Source: UpToDate.