Polycythemia Vera
Differential Diagnosis
Common Myeloproliferative Neoplasms - OverviewCML | PV | PMF | ET | |
---|---|---|---|---|
Tyrosine kinase | ABL | JAK2 | JAK2 or MPL | JAK2 or MPL |
Blood | ↑WBC with IG, basophils | Normo or hypochromatic anemia, may have ↑platelets & basophils | Leukoerythroblastic with teardrops | ↑Platelets, often abnormal |
Marrow | ↑↑Myeloids | Panmyelosis, ± erythroid hyperplasia, atypical megas | Panmyelosis, atypical megas | ↑↑Megas |
Marrow fibrosis | Varies | ↑In spent phase | ↑↑In fibrotic phase | Minimal |
Splenomegaly | ++ | ++ | +++ | ± |
Clinical Presentation /Other | B symptoms | Hypertension, thrombosis, pruritus,↓EPO | B symptoms, bleeding, gout | Thrombosis, hemorrhage |
Common Myeloproliferative Neoplasms - Peripheral Blood
CML | PV | Cellular Phase PMF | ET | |
---|---|---|---|---|
RBC | Normal or ↓ | Normal, ↑ or ↓, may be hypochromatic or polychromatic | ↓, teardrop cells | Normal or ↓ (iron deficient anemia) |
WBC | ↑, left shifted, basophilia, eosinophilia, rarely monocytosis | Normal or ↑, +/- basophils, (leukoerythroblastic ini fibrotic stage) | ↑granulocytes if leukoerythroblastic | Normal |
Platelets | Normal or ↑ | Normal or ↑ | Normal or ↑ | ↑ (>450 x103/μL) |
Hematolymphoid Disorders with Thrombocytosis
CML | PV | PMF, Cellular Phase | ET | RARS-T | 5q- | |
---|---|---|---|---|---|---|
Tyrosine kinase | ABL p230 variant* | JAK2 | JAK2 or MPL 50% | JAK2 or MPL 50% | JAK2 50% | JAK2 or MPL 10% |
Blood | ↑PMN, basophils, platelets | Normo or hypochromatic anemia, may have ↑basophils, platelets | Anemia, leukocytosis, ↑or nl platelets | ↑platelets, often abnormal | Dimorphic RBC, ↑platelets | Macrocytic anemia, ↑or nl platelets |
Marrow | ↑↑Myeloids, ↑dwarf megas | Panmyelosis, ±erythroid hyperplasia, atypical megas | Panmyelosis, atypical tightly clustered megas | ↑↑Megas | Erythroid dysplasia, ring sideroblasts, ↑megas | Erythroid hypoplasia, ↑small megas |
Marrow Fibrosis | Varies | ↑ in spent phase | ↑↑ in fibrotic phase | Minimal | Varies | Minimal |
Splenomegaly | ++ | ++ | +++ | ± | ± | Absent |
Clinical/Other | B symptoms | Hypertension, thrombosis, pruritus, ↓EPO | B symptoms, bleeding, gout | Thrombosis, hemorrhage | Anemia | Anemia |