Differential diagnosis

• Exclude other myeloproliferative disorders (CML, PV, ET) M7 AML (acute myelofibrosis), myelodysplasia, lymphoproliferative disorders (particularly hairy cell leukaemia), metastatic cancer (esp. breast, lung, prostate, stomach), tuberculosis, histoplasmosis and SLE.

• IMF is -ve for Ph chromosome and BCR-ABL fusion gene.

• Metastatic cancer in marrow, especially breast, prostate and thyroid, can give similar FBC features but without splenomegaly; metastatic carcinoma cells are apparent on marrow biopsy and/or aspirate.

• Prefibrotic stage recognised: classical features may be minimal or absent and difficult to distinguish from PRV/ET; prominent neutrophil proliferation, decreased erythroid precursors and markedly abnormal megakaryocytes.

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