Module overview
Section 2 of 6 · Open sections

Required section · Section 2 of 6

Mental model: three evidence domains

An MPN evaluation joins blood counts, marrow morphology, and molecular findings. Counts describe a pattern, marrow evaluates architecture and lineage morphology, and molecular testing supplies evidence of clonality. The domains answer different questions, so none replaces the others.

Polycythemia vera (PV) often has erythrocytosis with leukocytosis and thrombocytosis because of panmyelosis, meaning increased production in erythroid, granulocytic, and megakaryocytic lineages. Essential thrombocythemia (ET) centers on sustained thrombocytosis and a characteristic megakaryocyte pattern. Primary myelofibrosis (PMF) requires marrow-based assessment and can progress to a leukoerythroblastic blood pattern.

Use either WHO 5th edition or ICC 2022 criteria as named by the report pathway. Do not silently combine their details or turn criteria thresholds into general reference intervals. Identify the evidence domain that remains unaddressed before suggesting the next laboratory step.

Illustrative drawing — this picture was drawn rather than captured.

Triangle with blood counts, marrow morphology, and molecular testing at its points surrounding the statement that a pattern supports a classification workup, not a diagnosis.
Figure 1Counts, marrow morphology, and molecular testing are complementary evidence domains.

Reusable integrated evaluation model

  1. Verify the pattern

    Confirm persistence, inspect prior counts, and review the smear for artifacts and morphology.

  2. Consider mimics

    Assess reactive thrombocytosis and secondary or relative erythrocytosis context.

  3. Integrate studies

    Use the named classification framework with marrow and molecular findings.

Knowledge checks

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Knowledge check 1

Select the evidence domains that must be integrated for MPN classification workup.

Choose at least 3 options.

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