So… we have a leucoerythroblastic film (left shifted granulopoiesis and nucleated red cells) along with tear drop cells.
The main differentials the team came up with were:
- Myelofibrosis (primary or secondary – he did have a haematology past)
- Metastatic carcinoma
- Beta thalassaemia
- Iron deficiency
As us haematologists are keen we saw him for a marrow biopsy. We found out that he indeed previously had polycythaemia vera with the JAK2 V617F mutation. The initial marrow was a dry tap as expected… but we did see these cells after looking around for a while:
Here is part of the trephine:
The marrow infiltration was patchy and in other areas it was heavily fibrotic with no evidence of carcinoma. His ferritin was low and had iron deficiency.
Final diagnosis
- Metastatic adenocarcinoma – colonic
- Secondary (post polycythaemia) myelofibrosis
- Iron deficiency
