Dr. Ayesha Warsi

However, remember that lactate dehydrogenase as well as uric acid levels may also be elevated due to leukocytosis and high cell turnover seen in myelofibrosis.

Increased uric acid levels can also cause gout or uric acid stones.

Liver enzymes and liver function tests should also be checked to evaluate for consequences of hepatomegaly.

Alkaline phosphatase may be elevated due to bony involvement of the disease.

Finally, CRP and ESR may be elevated due to cytokine overproduction but are nonspecific.

Next, let's peek under the microscope and reach out to our friendly hematopathologist to help us interpret the peripheral blood smear.

Due to bone marrow infiltration by fibrotic tissue and decreased space for normal hematopoiesis, we may observe several consequences on the blood smear.

Red blood cells can get deformed as they squeeze out of the marrow to enter circulation.

Key findings related to this include teardrop-shaped red blood cells, also known as dacrocytes.

Additional findings suggestive of ineffective hematopoiesis may include poikilocytosis, abnormally shaped red blood cells.

Early immature cells may also be pushed out into the bloodstream.

This results in a leukoerythroblastic picture, which is a hallmark of primary myelofibrosis.

The blastic refers to the presence of immature cells such as blasts or megakaryocytes.

The leuko refers to the presence of immature white blood cells such as metamylocytes and mylocytes.

The erythro refers to the presence of immature red blood cells such as nucleated red cells.

Essential for diagnosis is the bone marrow biopsy.

In cases of myelofibrosis, the aspiration portion of the biopsy often yields a dry tap, meaning the bone marrow is so fibrotic that it is impossible to aspirate a liquid sample.

The core biopsy is necessary to demonstrate fibrosis, which is visualized with a silver reticulum stain or trichome stain.

Additional findings can include intravascular hematopoiesis and atypical megakaryocytic hyperplasia.

Myelofibrosis is classified as prefibrotic myelofibrosis or overt myelofibrosis based on the degree of underlying fibrotic changes seen in the bone marrow.