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.”
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