Case 66 – update 2

All reactive causes of thrombocytosis have been ruled out and our pregnant patient has a persistently elevated platelet count of 500×10*9/L. There is no history of VTE or miscarriage. There are no systemic symptoms such as weight loss, rash or sweats. She is fatigued but iron replacement has helped with this. The blood film shows some mild platelet anisocytosis but no tear drop cells or nucleated red cells.

 

Further testing as requested has revealed:

  • JAK2 V617F mutation – detected
  • MPL exon 10 mutation (W515) – negative
  • CALR exon 9 mutation – negative
  • FISH for t(9;22), BCR-ABL1 – negative

 

Questions

  • How should the patient be managed from a haematology and obstetric point of view?
  • Would you perform a bone marrow biopsy?

 

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