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.”
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