Myeloid Neoplasms in the Guise of Nutritional Deficiency

Veda Parthasarathy

doi:10.1155/2012/826939

Abstract

The classic BCR-ABL-negative myeloproliferative neoplasms (MPNs) which include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) are among the most frequent hematologic neoplasms. Because of their relatively smooth clinical course, it is likely that many of these MPNs actually go undetected. Considering the high prevalence of iron, folic-acid, and vitamin B12 deficiencies in developing countries, their coexistence with MPN can be expected frequently. In such situations where both disorders coexist, MPN is often overlooked. This causes considerable diagnostic delay. In this paper, two cases of PMF and one case of PV where the diagnosis of MPN was delayed for about 3 years are discussed. Presence of concomitant vitamin B12, folate, and iron deficiencies perhaps camouflaged the underlying MPN. Bearing in mind the possibility of MPN, even in the setting of apparent nutritional deficiency and performing a bone marrow evaluation, is the crucial step in unveiling the hidden MPN.

Highlights

Myeloproliferative neoplasms (MPNs) are among the most frequent hematologic neoplasms, usually affecting the middle aged and elderly [1]
Case 1 illustrates primary myelofibrosis (PMF) presenting as recurrent nutritional deficiency anemia
As nutritional deficiency is widely prevalent in India, further investigations to unveil the cause of anemia were not pursued for long

Summary

Introduction

Myeloproliferative neoplasms (MPNs) are among the most frequent hematologic neoplasms, usually affecting the middle aged and elderly [1]. “Classic BCR-ABL-negative (Philadelphia negative) MPN” is an operational subcategory [2, 3] which includes polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Because of their relatively smooth clinical course, it is likely that many classic BCR-ABL negative MPN cases go undetected. Deficiencies of iron, folic acid, and Vitamin B12 are known to occur in association with BCR-ABLnegative MPNs [4,5,6]. These deficiencies may be coincident, secondary, or perhaps a manifestation of the underlying MPN. This paper illustrates three cases of BCR-ABL-negative MPN which went unnoticed for few years owing to concurrent nutritional deficiencies

Case 1

Case 2

Case 3

Findings

Discussion