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What is the most appropriate next step in the management?

waelhammad
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2022-11-15
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A 65-year-old male presen ts for further evaluation secondary to progressive dyspnea on exertion, orthopnea, and left upper quadran t abdomi nal pai n. Physical examination reveals massive splenomegaly and bilateral lower extremi ty edema. Laboratory workup shows hemoglobin of 9.3 g/dl, leukocyte count of 1 8, 500/JLL, and platelets of LJ58,000/JLL. Peripheral blood smear is shown below.

What is the most appropriate next step in the management?

  1. Testing for JAK2 mutation
  2. Testing for MPL mutation
  3. Testing for BCR-ABL translocation
  4. Bone marrow biopsy
  5. Both A and C
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waelhammad
2022-11-15
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E. Mutations in JAK2 have been reported in approximately 50% of cases with myelofibrosis (NE]M. 2005;352(17):1 779, Blood. 2005;106(6):2162). Mutations in MPL gene have been reported in 5% of cases with myelofibrosis regardless of JAK2 mutational status and in approximately 10% of cases with JAK2 negative myelofibrosis. Test for BCR-ABL is required to rule out CML (Blood. 2006;108(10):3472, Br ] Haematol. 2010;149(2):250).

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