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Peripheral blood smear and bone marrow examination helps in making the diagnosis of myelofibrosis. Various tests performed to aid in reaching the diagnosis include complete blood count, peripheral blood smear and bone marrrow examination, complete metabolic panel, and leukocyte alkaline phosphatase test.
Peripheral blood smear and bone marrow examination helps in making the diagnosis of myelofibrosis. Various tests performed to aid in reaching the diagnosis include complete blood count, peripheral blood smear and bone marrrow examination, complete metabolic panel, and leukocyte alkaline phosphatase test.


==Laboratory Tests==
==Laboratory Findings==
Laboratory findings consistent with the diagnosis of myelofibrosis include:<ref name=wikidiagn1osismf1>Diagnosis of myelofibrosis. Wikipedia 2016. https://en.wikipedia.org/wiki/Myelofibrosis. Accessed on March 8, 2016</ref><ref name=cancercaidiopathicmyelofibrosisdx1>Diagnosis of idiopathic myelofibrosis. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/leukemia/leukemia/idiopathic-myelofibrosis/?region=on. Accessed on March 9, 2016</ref>
 
===Complete Blood Count===
===Complete Blood Count===
*[[anemia|Decreased red blood cells]]
*[[anemia|Decreased red blood cells]]<ref name="pmid16202684">{{cite journal |vauthors=Thiele J, Kvasnicka HM |title=Hematopathologic findings in chronic idiopathic myelofibrosis |journal=Semin. Oncol. |volume=32 |issue=4 |pages=380–94 |date=August 2005 |pmid=16202684 |doi=10.1053/j.seminoncol.2005.04.010 |url=}}</ref><ref name="pmid26891375">{{cite journal |vauthors=Cervantes F, Correa JG, Hernandez-Boluda JC |title=Alleviating anemia and thrombocytopenia in myelofibrosis patients |journal=Expert Rev Hematol |volume=9 |issue=5 |pages=489–96 |date=May 2016 |pmid=26891375 |doi=10.1586/17474086.2016.1154452 |url=}}</ref><ref name="pmid28009442">{{cite journal |vauthors=Hernández-Boluda JC, Correa JG, García-Delgado R, Martínez-López J, Alvarez-Larrán A, Fox ML, García-Gutiérrez V, Pérez-Encinas M, Ferrer-Marín F, Mata-Vázquez MI, Raya JM, Estrada N, García S, Kerguelen A, Durán MA, Albors M, Cervantes F |title=Predictive factors for anemia response to erythropoiesis-stimulating agents in myelofibrosis |journal=Eur. J. Haematol. |volume=98 |issue=4 |pages=407–414 |date=April 2017 |pmid=28009442 |doi=10.1111/ejh.12846 |url=}}</ref>
*[[Hemoglobin|Reduced hemoglobin]]
*[[Hemoglobin|Reduced hemoglobin]]
*[[thrombocytopenia|Decreased platelets]]
*[[thrombocytopenia|Decreased platelets]]<ref name="pmid27315113">{{cite journal |vauthors=Barraco D, Lasho TL, Gangat N, Finke C, Elala YC, Pardanani A, Tefferi A |title=Leukocytosis and presence of CALR mutation is associated with non-hepatosplenic extramedullary hematopoiesis in primary myelofibrosis |journal=Blood Cancer J |volume=6 |issue= |pages=e436 |date=June 2016 |pmid=27315113 |pmc=5141359 |doi=10.1038/bcj.2016.44 |url=}}</ref><ref name="pmid27293069">{{cite journal |vauthors=Beauverd Y, Alimam S, McLornan DP, Radia DH, Harrison CN |title=Disease characteristics and outcomes in younger adults with primary and secondary myelofibrosis |journal=Br. J. Haematol. |volume=175 |issue=1 |pages=37–42 |date=October 2016 |pmid=27293069 |doi=10.1111/bjh.14173 |url=}}</ref><ref name="pmid25519030">{{cite journal |vauthors=Ota S, Hiramatsu Y, Kondo E, Kasahara A, Takada S, Umena S, Noguchi T, Tanimoto M, Matsumura T |title=Severe case of peripheral leukocytosis initially diagnosed as myelodysplastic syndrome/myeloproliferative neoplasm, unclassifiable, but possibly prefibrotic primary myelofibrosis |journal=Acta Med. Okayama |volume=68 |issue=6 |pages=363–8 |date=December 2014 |pmid=25519030 |doi=10.18926/AMO/53025 |url=}}</ref><ref name="pmid29096334">{{cite journal |vauthors=Scotch AH, Kosiorek H, Scherber R, Dueck AC, Slot S, Zweegman S, Boekhorst PAWT, Commandeur S, Schouten H, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA, Geyer HL |title=Symptom burden profile in myelofibrosis patients with thrombocytopenia: Lessons and unmet needs |journal=Leuk. Res. |volume=63 |issue= |pages=34–40 |date=December 2017 |pmid=29096334 |doi=10.1016/j.leukres.2017.10.002 |url=}}</ref><ref name="pmid25521305">{{cite journal |vauthors=Wassie E, Finke C, Gangat N, Lasho TL, Pardanani A, Hanson CA, Ketterling RP, Tefferi A |title=A compendium of cytogenetic abnormalities in myelofibrosis: molecular and phenotypic correlates in 826 patients |journal=Br. J. Haematol. |volume=169 |issue=1 |pages=71–6 |date=April 2015 |pmid=25521305 |doi=10.1111/bjh.13260 |url=}}</ref><ref name="pmid27264006">{{cite journal |vauthors=Guglielmelli P, Rotunno G, Pacilli A, Rumi E, Rosti V, Delaini F, Maffioli M, Fanelli T, Pancrazzi A, Pieri L, Fjerza R, Pietra D, Cilloni D, Sant'Antonio E, Salmoiraghi S, Passamonti F, Rambaldi A, Barosi G, Barbui T, Cazzola M, Vannucchi AM |title=Prognostic impact of bone marrow fibrosis in primary myelofibrosis. A study of the AGIMM group on 490 patients |journal=Am. J. Hematol. |volume=91 |issue=9 |pages=918–22 |date=September 2016 |pmid=27264006 |doi=10.1002/ajh.24442 |url=}}</ref><ref name="pmid28153839">{{cite journal |vauthors=Xu Z |title=MDS/MPN with ring sideroblasts and thrombocytosis masquerading as prefibrotic/early primary myelofibrosis |journal=Blood |volume=129 |issue=5 |pages=657 |date=February 2017 |pmid=28153839 |doi=10.1182/blood-2016-11-749937 |url=}}</ref><ref name="pmid23498669">{{cite journal |vauthors=Cheminant M, Delarue R |title=[Investigation and management of patients presenting with thrombocytosis] |language=French |journal=Rev Med Interne |volume=34 |issue=8 |pages=465–71 |date=August 2013 |pmid=23498669 |doi=10.1016/j.revmed.2013.02.020 |url=}}</ref>
*[[leukopenia|Decreased white blood cells]]
*[[leukopenia|Decreased white blood cells]]


===Peripheral Blood Smear===
===Peripheral Blood Smear===
*[[Normochromic]] normocytic [[anemia]]
*[[Normochromic]] normocytic [[anemia]]<ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>
*Red cell [[poikilocytosis]] on blood film (tear-drop shaped RBCs)
*Tear-drop shaped red blood cells (RBCs)<ref name="pmid26118701">{{cite journal |vauthors=Egelé A, van Gelder W, Riedl J |title=Automated detection and classification of teardrop cells by a novel RBC module using digital imaging/microscopy |journal=Int J Lab Hematol |volume=37 |issue=6 |pages=e153–6 |date=December 2015 |pmid=26118701 |doi=10.1111/ijlh.12399 |url=}}</ref>
*Nucleated red blood cells
*Erythroblastosis<ref name="pmid12412736">{{cite journal |vauthors=Tóth P, Tóth Z |title=Idiopathic myelofibrosis with prominent postsplenectomy erythroblastosis terminating in acute myeloid transformation |journal=Haematologia (Budap) |volume=32 |issue=2 |pages=155–61 |date=2002 |pmid=12412736 |doi= |url=}}</ref><ref name="pmid8638637">{{cite journal |vauthors=Osman Y, Kishi K, Narita M, Saito H, Masuko M, Koike T, Shibata A |title=Idiopathic myelofibrosis with unusually high erythroblastosis in the peripheral blood |journal=Am. J. Hematol. |volume=52 |issue=2 |pages=122–3 |date=June 1996 |pmid=8638637 |doi=10.1002/(SICI)1096-8652(199606)52:2<122::AID-AJH12>3.0.CO;2-J |url=}}</ref>
:*Presence of nucleated red blood cells suggests that immature cells are being released into the bloodstream in response to a very high demand for the bone marrow to produce new red blood cells.
*[[Thrombocytopenia]]<ref name="pmid29096334">{{cite journal |vauthors=Scotch AH, Kosiorek H, Scherber R, Dueck AC, Slot S, Zweegman S, Boekhorst PAWT, Commandeur S, Schouten H, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA, Geyer HL |title=Symptom burden profile in myelofibrosis patients with thrombocytopenia: Lessons and unmet needs |journal=Leuk. Res. |volume=63 |issue= |pages=34–40 |date=December 2017 |pmid=29096334 |doi=10.1016/j.leukres.2017.10.002 |url=}}</ref>
*[[Thrombocytopenia]]
*[[megakaryocytes|Dysplastic megakaryocytes]]<ref name="pmid8435338">{{cite journal |vauthors=Reilly JT, Barnett D, Dolan G, Forrest P, Eastham J, Smith A |title=Characterization of an acute micromegakaryocytic leukaemia: evidence for the pathogenesis of myelofibrosis |journal=Br. J. Haematol. |volume=83 |issue=1 |pages=58–62 |date=January 1993 |pmid=8435338 |doi= |url=}}</ref>
*[[megakaryocytes|Dysplastic megakaryocytes]]
*Fibroblast-like and myofibroblast-like reticulum cells on bone marrow study<ref name="pmid2580387">{{cite journal |vauthors=Biagini G, Severi B, Govoni E, Preda P, Pileri S, Martinelli G, Visani G, Finelli C, Castaldini C |title=Stromal cells in primary myelofibrosis: ultrastructural observations |journal=Virchows Arch., B, Cell Pathol. |volume=48 |issue=1 |pages=1–8 |date=1985 |pmid=2580387 |doi= |url=}}</ref><ref name="pmid20430444">{{cite journal |vauthors=Muth M, Büsche G, Bock O, Hussein K, Kreipe H |title=Aberrant proplatelet formation in chronic myeloproliferative neoplasms |journal=Leuk. Res. |volume=34 |issue=11 |pages=1424–9 |date=November 2010 |pmid=20430444 |doi=10.1016/j.leukres.2010.03.040 |url=}}</ref>


===Complete Metabolic Panel===
===Complete Metabolic Panel===

Revision as of 18:30, 5 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Peripheral blood smear and bone marrow examination helps in making the diagnosis of myelofibrosis. Various tests performed to aid in reaching the diagnosis include complete blood count, peripheral blood smear and bone marrrow examination, complete metabolic panel, and leukocyte alkaline phosphatase test.

Laboratory Findings

Complete Blood Count

Peripheral Blood Smear

Complete Metabolic Panel

Leukocyte Alkaline Phosphatase Test (LAP Test)

References

  1. ↑ Thiele J, Kvasnicka HM (August 2005). "Hematopathologic findings in chronic idiopathic myelofibrosis". Semin. Oncol. 32 (4): 380–94. doi:10.1053/j.seminoncol.2005.04.010. PMID 16202684.
  2. ↑ Cervantes F, Correa JG, Hernandez-Boluda JC (May 2016). "Alleviating anemia and thrombocytopenia in myelofibrosis patients". Expert Rev Hematol. 9 (5): 489–96. doi:10.1586/17474086.2016.1154452. PMID 26891375.
  3. ↑ Hernández-Boluda JC, Correa JG, García-Delgado R, Martínez-López J, Alvarez-Larrán A, Fox ML, García-Gutiérrez V, Pérez-Encinas M, Ferrer-Marín F, Mata-Vázquez MI, Raya JM, Estrada N, García S, Kerguelen A, Durán MA, Albors M, Cervantes F (April 2017). "Predictive factors for anemia response to erythropoiesis-stimulating agents in myelofibrosis". Eur. J. Haematol. 98 (4): 407–414. doi:10.1111/ejh.12846. PMID 28009442.
  4. ↑ Barraco D, Lasho TL, Gangat N, Finke C, Elala YC, Pardanani A, Tefferi A (June 2016). "Leukocytosis and presence of CALR mutation is associated with non-hepatosplenic extramedullary hematopoiesis in primary myelofibrosis". Blood Cancer J. 6: e436. doi:10.1038/bcj.2016.44. PMC 5141359. PMID 27315113.
  5. ↑ Beauverd Y, Alimam S, McLornan DP, Radia DH, Harrison CN (October 2016). "Disease characteristics and outcomes in younger adults with primary and secondary myelofibrosis". Br. J. Haematol. 175 (1): 37–42. doi:10.1111/bjh.14173. PMID 27293069.
  6. ↑ Ota S, Hiramatsu Y, Kondo E, Kasahara A, Takada S, Umena S, Noguchi T, Tanimoto M, Matsumura T (December 2014). "Severe case of peripheral leukocytosis initially diagnosed as myelodysplastic syndrome/myeloproliferative neoplasm, unclassifiable, but possibly prefibrotic primary myelofibrosis". Acta Med. Okayama. 68 (6): 363–8. doi:10.18926/AMO/53025. PMID 25519030.
  7. ↑ 7.0 7.1 Scotch AH, Kosiorek H, Scherber R, Dueck AC, Slot S, Zweegman S, Boekhorst P, Commandeur S, Schouten H, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA, Geyer HL (December 2017). "Symptom burden profile in myelofibrosis patients with thrombocytopenia: Lessons and unmet needs". Leuk. Res. 63: 34–40. doi:10.1016/j.leukres.2017.10.002. PMID 29096334. Vancouver style error: initials (help)
  8. ↑ Wassie E, Finke C, Gangat N, Lasho TL, Pardanani A, Hanson CA, Ketterling RP, Tefferi A (April 2015). "A compendium of cytogenetic abnormalities in myelofibrosis: molecular and phenotypic correlates in 826 patients". Br. J. Haematol. 169 (1): 71–6. doi:10.1111/bjh.13260. PMID 25521305.
  9. ↑ Guglielmelli P, Rotunno G, Pacilli A, Rumi E, Rosti V, Delaini F, Maffioli M, Fanelli T, Pancrazzi A, Pieri L, Fjerza R, Pietra D, Cilloni D, Sant'Antonio E, Salmoiraghi S, Passamonti F, Rambaldi A, Barosi G, Barbui T, Cazzola M, Vannucchi AM (September 2016). "Prognostic impact of bone marrow fibrosis in primary myelofibrosis. A study of the AGIMM group on 490 patients". Am. J. Hematol. 91 (9): 918–22. doi:10.1002/ajh.24442. PMID 27264006.
  10. ↑ Xu Z (February 2017). "MDS/MPN with ring sideroblasts and thrombocytosis masquerading as prefibrotic/early primary myelofibrosis". Blood. 129 (5): 657. doi:10.1182/blood-2016-11-749937. PMID 28153839.
  11. ↑ Cheminant M, Delarue R (August 2013). "[Investigation and management of patients presenting with thrombocytosis]". Rev Med Interne (in French). 34 (8): 465–71. doi:10.1016/j.revmed.2013.02.020. PMID 23498669.
  12. ↑ Hoffman, Ronald (2018). Hematology : basic principles and practice. Philadelphia, PA: Elsevier. ISBN 9780323357623.
  13. ↑ Egelé A, van Gelder W, Riedl J (December 2015). "Automated detection and classification of teardrop cells by a novel RBC module using digital imaging/microscopy". Int J Lab Hematol. 37 (6): e153–6. doi:10.1111/ijlh.12399. PMID 26118701.
  14. ↑ Tóth P, Tóth Z (2002). "Idiopathic myelofibrosis with prominent postsplenectomy erythroblastosis terminating in acute myeloid transformation". Haematologia (Budap). 32 (2): 155–61. PMID 12412736.
  15. ↑ Osman Y, Kishi K, Narita M, Saito H, Masuko M, Koike T, Shibata A (June 1996). "Idiopathic myelofibrosis with unusually high erythroblastosis in the peripheral blood". Am. J. Hematol. 52 (2): 122–3. doi:10.1002/(SICI)1096-8652(199606)52:2<122::AID-AJH12>3.0.CO;2-J. PMID 8638637.
  16. ↑ Reilly JT, Barnett D, Dolan G, Forrest P, Eastham J, Smith A (January 1993). "Characterization of an acute micromegakaryocytic leukaemia: evidence for the pathogenesis of myelofibrosis". Br. J. Haematol. 83 (1): 58–62. PMID 8435338.
  17. ↑ Biagini G, Severi B, Govoni E, Preda P, Pileri S, Martinelli G, Visani G, Finelli C, Castaldini C (1985). "Stromal cells in primary myelofibrosis: ultrastructural observations". Virchows Arch., B, Cell Pathol. 48 (1): 1–8. PMID 2580387.
  18. ↑ Muth M, Büsche G, Bock O, Hussein K, Kreipe H (November 2010). "Aberrant proplatelet formation in chronic myeloproliferative neoplasms". Leuk. Res. 34 (11): 1424–9. doi:10.1016/j.leukres.2010.03.040. PMID 20430444.


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