Case 13 – update 4

You are concerned the patient has a primary haematological disorder due to persistence of thrombocytosis, with reactive causes being ruled out.

Further appropriate investigations include:

  • Careful study of the FBC, particularly white cell differential for basophils, monocytes and eosinophils and the haematocrit (we need to rule out a primary polycythaemia or portiential CML or CMML)
  • Review of the blood film for dysplastic changes (could this be an atypical myelodysplastic syndrome with thrombocytosis) or left shifted granulocytes (could this be CML?).  Variation in platelet size (ansiocytosis) may point towards a primary haematological problem.
  • USS abdo if concerns or uncertainties about the absence or presence of splenomegaly
  • JAK-2 V617F mutation (which renders haematopoietic stem cells more sensitive to growth factors)
  • MPL mutation (often done automatically if JAK-2 V617F is negative)

His blood film does show platelet ansiocytosis but no other abnormal features.  the haematocrit and white cell differential are normal and there is no splenomegaly or worrying features in the history.

His JAK2 V617 mutation is positive

Questions

  • To marrow or not?
  • What drug therapy would you use?
  • Do you tell the patient they have a malignancy?

Please reply on Twitter and include #TeamHaem

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion

About TeamHaem

Online education and discussion about all things haematological
This entry was posted in Myeloproliferative neoplasm, Platelet disorders, Related to other specialities and tagged , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s