Osteoblasts to the Rescue – A Rare Case of Secondary Myelofibrosis

Abstract

A 36-year-old female patient presented with joint pain, generalized weakness, and bleeding gums. There was no significant history of other illnesses or intake of drugs. Examination revealed pallor and splenomegaly. Peripheral smear examination showed pancytopenia. A large number of osteoblasts and a few scattered osteoclasts were seen in the bone marrow aspirate. The trephine biopsy revealed marrow fibrosis. A suggestion to investigate for hyperparathyroidism was made. Serum calcium, ionized calcium, and PTH were increased. 99m Tc-Sestamibi scan was done and adenoma was detected in the right inferior parathyroid and subsequently excised. Postsurgery, hematological parameters and bone markers improved. Follow-up bone marrow biopsy revealed hypercellular marrow with marked regression of fibrosis. Splenomegaly was reversed. We concluded that pancytopenia was due to bone marrow fibrosis, resulting from primary hyperparathyroidism. It is important to consider secondary causes of myelofibrosis in the appropriate clinical setting.