Case 143: update 2

This man is referred to the haematology clinic. Apart from his recent hospital admission, there is
nothing else of note in his history apart from the fact that he smokes. Examination is also

You organise JAK2 testing, an ultrasound of his abdomen and a bone marrow biopsy. Results are as

JAK2 V617F detected (40%). Other pathogenic variants not detected.

Ultrasound abdomen: splenomegaly (14cm), otherwise unremarkable.

Bone marrow biopsy:

Bone marrow aspirate
Bone marrow trephine (H&E)
Bone marrow trephine (reticulin)

What is the likely diagnosis and what are the management options?

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