June 2016

• A 72-year old male presents to his primary care physician with fatigue, abdominal pain lasting 3 months, and night sweats
• PMH includes depression and gout
• Physical Exam: BP, 155/85; spleen palpable 6 cm below costal margin
• Laboratory values:
  • Hb= 9.8 g/L
  • HCT= 38%
  • WBC= 22.3 x10⁹/L
  • Platelets= 255 x10⁹/L
• Bone marrow biopsy:
  • Megakaryocytic proliferation and atypia with evidence of reticulin fibrosis
• Blood smear showed leukoerythroblastosis
• Genetic testing showsJAK2 V617Fmutation
• Diagnosis: Primary myelofibrosis