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Paritosh Garg: A fibrotic marrow is not always PMF
Paritosh Garg/LinkedIn
Apr 12, 2026, 14:15

Paritosh Garg: A fibrotic marrow is not always PMF

Paritosh Garg, Associate Consultant at Fortis Memorial Research Institute, India, shared a post on LinkedIn:

“A fibrotic marrow is not always PMF.

One recent case reminded me of this very clearly.

A young woman presented with severe cytopenias, a leucoerythroblastic smear, and grade 2 marrow fibrosis.

The initial marrow appearance was concerning — but the rest of the story mattered.

There was:

  • no splenomegaly
  • no atypical megakaryocytes
  • no significant dysplasia
  • no convincing clonal marker
  • autoimmune features supporting an immune-mediated process

Her treatment journey was equally telling:

  • relapsed on steroids
  • did not respond to MMF / cyclosporine / danazol
  • finally responded to rituximab

For me, the takeaway was powerful:

  • when fibrosis is seen in the marrow, especially in a young patient with autoimmune clues, autoimmune myelofibrosis must remain on the radar.

In hematology, morphology opens the door.

But diagnosis still belongs to the whole clinical picture.”

Paritosh Garg: A fibrotic marrow is not always PMF

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