BOF: Malignant (Myeloproliferative Disorder)

A 59 year old man is known to have a JAK2 V617F mutated polycythaemia. He has been maintained on a venesection programme for the last 6 years and has had no thrombotic complications. He is now complaining of increasing tiredness and some night sweats. His current FBC is Hb 9.9g/dL, MCV 70 fl, Neutrophils 5.3 x 10⁹/L, Platelets 712 x 10⁹/L, Ferritin 9.

Which of the following options would be the most appropriate next step?

a) Bone marrow biopsy

b) Iron supplementation

c) Hydroxycarbamide

d) Recombinant human erythropoietic proteins (rHuEpo)

e) Top-up transfusion

Answer:

Bone marrow biopsy

Reference:

Beer PA, Erber WN, Campbell PJ, Green AR. How I treat essential thrombocythemia. Blood 2011;117(5):1472-1482