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Treated for Essential Thrombocythemia. On low dose of aspirin. Advised to take bone marrow test. Need second opinion?

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General & Family Physician
Practicing since : 2004
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Posted Wed, 13 Nov 2013 in General Health
Answered by Dr. Chakravarthy Mazumdar 2 days later
Brief Answer:
Need more details.

Detailed Answer:

I asked everyone here, what is ET? Is it Essential Thrombocythemia?. Can you please expand it? What is Jaxx factor? Is it JAK2 mutation?

Was the bone marrow test not done before the ET treatment three years ago? Actually it is a disease of the stem cells of the bone marrow. It is very tricky to diagnose this condition and there are many diagnostic crietrion invoving it. I found this which may be of interest to you from doctors library called Epocrates Library

Proposed WHO / British diagnostic criteria for essential thrombocythemia:

A1: sustained platelet count >450,000/microliter

A2: presence of an acquired pathogenetic mutation (e.g., in the JAK2 or MPL genes)

A3: no other myeloid malignancy, especially polycythemia vera, primary myeloid fibrosis chronic myeloid leukemia, or myelodysplastic syndrome. Polycythemia vera is excluded by a normal hematocrit in an iron-replete patient. Primary myeloid fibrosis is indicated by the presence of significant bone marrow fibrosis (≥2/3 or 3/4 reticulin) and palpable splenomegaly, blood film abnormalities (circulating progenitors and teardrop cells), or unexplained anemia. Chronic myeloid leukemia is excluded by the absence of BCR-ABL1 fusion from bone marrow or peripheral blood. Myelodysplastic syndrome is excluded by absence of dysplasia on examination of blood film and bone marrow aspirate

A4: no reactive cause for thrombocytosis and normal iron stores

A5: bone marrow aspirate and trephine biopsy showing increased megakaryocyte numbers displaying a spectrum of morphology with predominant large megakaryocytes with hyperlobulated nuclei and abundant cytoplasm. Reticulin is generally not increased (grades 0 to 2/4 or grade 0/3).

A diagnosis can be made if patients XXXXXXX criteria A1, A2, and A3. If patients do not have an acquired pathogenetic mutation, a diagnosis can be made if patients XXXXXXX criteria A1, A3, A4, and A5.

I think only a practising hematologist would be able to give you a better answer than me. I generally refer such rare and complex cases to Hematology colleagues. I have put the facts above.

Thank you
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