Transition from polycythaemia vera to myelofibrosis with myeloid metaplasia: A case report.

ABSTRACT

An 80-year-old woman was admitted to the hospital with of pain in the right upper abdominal region. She had splenomegaly and CT scan showed gall stones and splenic infarction. Blood examination revealed erythrocytosis, raised LAP, elevated serum vitamin B12, vitamin B12 binding proteins and reversed TCI/TCIII ratio. All these findings confirmed the diagnosis of polycythaemia vera. After splenectomy and cholecystectomy, a leucoerythroblastic blood picture with teardrop poikilocytosis was detected in the peripheral blood smear. The haemoglobin concentration decreased but leucocytosis and thrombocytosis still persisted. Bone marrow aspirate showed erythroid hypoplasia, decreased megakaryocytes and some degree of fibrosis. This was compatible with the criterial diagnosis of myelofibrosis with myeloid metaplasia. Blood transfusions and myleran were given. Peritoneal dialysis was performed and the patient had severe bleeding and died from cardiac failure due to septic shock. This patient is an example of the transition from polycythaemia vera to myelofibrosis with myeloid metaplasia.