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Hisam Siddiqi: Understanding Bone Marrow Trephine Morphology in MPNs
Hisam Siddiqi/LinkedIn
Apr 8, 2026, 17:56

Hisam Siddiqi: Understanding Bone Marrow Trephine Morphology in MPNs

Hisam Siddiqi, Consultant Haematologist at LycaHealth, The Blackheath Hospital, Dartford and Gravesham NHS Trust, shared a post on LinkedIn:

“Understanding Bone Marrow Trephine Morphology in MPNs – A Simple Breakdown

Myeloproliferative neoplasms (MPNs) can often look similar clinically, but the bone marrow trephine provides important clues that help us distinguish between them.

Here’s a quick, simplified guide to typical findings across the main MPN subtypes, based on key features: cellularity, megakaryocyte morphology, clustering patterns, and reticulin fibrosis.

Polycythaemia Vera (PRV)

  • Cellularity: Very high (panmyelosis – all cell lines increased)
  • Megakaryocytes: Mildly increased
  • Clusters: Usually absent
  • Reticulin: Normal or slightly up
  • Think: a busy marrow with everything ‘turned up.’

Essential Thrombocythaemia (ET)

  • Cellularity: Normal
  • Megakaryocytes: Markedly increased, hyperlobulated (‘staghorn’)
  • Clusters: None or loose
  • Reticulin: Normal or slightly up
  • Think: lots of large, mature megakaryocytes with big, multilobed nuclei.

Pre‑Fibrotic Myelofibrosis (pre‑MF)

  • Cellularity: Increased
  • Megakaryocytes: Variable up; abnormally shaped, atypical, hypolobulated
  • Clusters: Small, dense or loose
  • Reticulin: Mildly up
  • Think: dysplastic megakaryocytes plus early scarring.

Overt Myelofibrosis (MF)

  • Cellularity: Often reduced
  • Megakaryocytes: Increased, hypolobulated / atypical
  • Clusters: Dense, tight clusters
  • Reticulin: Marked fibrosis with collagen deposition
  • Think: fibrotic, scarred marrow with abnormal megakaryocyte clusters.

Why this matters:

Trephine morphology remains central to accurate MPN diagnosis and helps guide prognosis and treatment decisions. Recognising these hallmark patterns can refine our diagnostic confidence and improve patient care.”

Hisam Siddiqi

More posts featuring Hisam Siddiqi on Hemostasis Today.

Bone Marrow Trephine Morphology Essential Thrombocythaemia ET Health Hematology Hemostasis Hemostasis News Hemostasis Today Hisam Siddiqi Medicine MF MPN Overt Myelofibrosis Polycythaemia Vera Pre‑Fibrotic Myelofibrosis pre‑MF PRV
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