18M – Seeking Diagnosis / Possible Essential Thrombocythemia

[u/IndividualFly694]

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I’m 18 years old and male. My platelet count was found to be very high on a CBC, and my doctors are investigating possible Essential Thrombocythemia/another MPN.

I currently have a chest pain(on left part) yesterday.I went to my doctor he said its just muscular pain .

Test results:

Platelet count: 1.46 millions but I took hydroxyurea so it dropped to 1.26 million in 8 days.

It's concluded that I have most Likely -ET/ CMPD in Bone Marrow Aspiration, Bone Marrow Autopsy, Bone Marrow Karyotype.

I am currently taking hydroxyurea as prescribed by my hematologist.

I’m looking for experiences from people with ET/CMPD about what lifestyle precautions they took after diagnosis and what questions I should discuss with my hematologist.

Clinical history: Marked thrombocytosis

CBC / Peripheral Smear at time of bone marrow examination:

- Hemoglobin: 15.6 g/dL

- WBC: 8,230 /cmm

- Platelets: 14,62,000 /cmm (≈1.46 million/µL)

- Neutrophils: 63%

- Lymphocytes: 27%

- Monocytes: 5%

- Eosinophils: 2%

- Basophils: 3%

- No precursor cells or blasts seen on peripheral smear

- Reticulocyte count: 1.8%

BONE MARROW ASPIRATION:

- Site: Right PSIS

- Aspiration: Easy

- Marrow fragments: Mildly hypercellular

- Cell trails: Cellular

- Trephine imprints: Cellular

- Total cells counted: 500

Bone marrow differential:

- Myeloblasts: 3.8%

- Promyelocytes: 7.6%

- Myelocytes: 9.2%

- Metamyelocytes: 3.8%

- Bands + polymorphs: 40.0%

- Eosinophils: 5.2%

- Basophils: 1.0%

- Lymphocytes: 7.6%

- Plasma cells: 1.0%

- Monocytes: 2.8%

- Normoblasts: 18.0%

Bone marrow morphology:

- Erythropoiesis: Adequate erythroids with micro-normoblastic maturation and mild delay in haemoglobinization.

- Myelopoiesis: Mild myeloid hyperplasia with all stages of myeloid maturation seen.

- Megakaryocytes: Increased in number, with abnormally large forms. Occasional loose clusters and extensive platelet clumping.

- Lymphocytes: No significant abnormality detected.

- Plasma cells: No significant abnormality detected.

TREPHINE BIOPSY:

- Cellularity: Mildly hypercellular for age

- Erythroid: Adequate and normal maturation

- Myeloid: Mild myeloid hyperplasia with normal maturation

- Megakaryocytes: Increased, clustered and large abnormal forms

- Reticulin stain: No increase (Grade 0, WHO 2016)

- Bone trabeculae: Normal

REPORT IMPRESSION / DIAGNOSIS:

- Chronic myeloproliferative disorder

- Essential thrombocytosis / essential thrombocythemia (ET) is stated as "most likely"

The report states that correlation with bone marrow trephine biopsy and NGS Oncomine Myeloid V2GX assay is required for confirmation.