Myelofibrosis Diagnosed through the Explant Liver Way!

Cryptogenic chronic liver disease (CLD) remain an important cause of chronic liver disease where no etiological inciting agent could be attributed to causation of disease. With recent advances in diagnostic testing the prevalence of cryptogenic CLD have decreased though not completely eliminated. We report a case of a 45-year-old female who underwent combined liver and kidney transplant for cryptogenic chronic liver and kidney disease. Her explant liver pathology revealed extensive extramedullary hematopoiesis with many atypical megakaryocytes and advance fibrosis. She subsequently underwent bone marrow aspiration and biopsy and was finally diagnosed as a case of primary myelofibrosis. Post transplant her platelet count peaked to 12 lakhs and she was started on hydroxyurea. Her platelets became normal following 2 weeks of therapy and dropped to about 4 lakhs.