66 year old white male with weakness and increasing abdominal girth admitted for evaluation. He stated that several years prior he had an increased blood cell count on a routine blood test. His spleen was palpable 10 cm below the LCM  and liver palpable 4 cm below the RCM. No lymphadenopathy.

Hgb - 9.7 gm/dl            WBC    -  3.7 x 10⁹/l
Hct - 31%                  Polys  -  1.9 x 10⁹/l
                           Bands  -  0.9 x 10⁹/l
                           Metas  - 0.15 x 10⁹/l
                           Lymphs -  0.5 x 10⁹/l
                           Monos  -  .02 x 10⁹/l
                           Eos    -  .05 x 10⁹/l
                           Baso   -  .05 x 10⁹/l
Platelets - 250 x 10⁹/l
11 nucleated RBC’s/lOO WBC

    Bone marrow aspiration: dry tap
    Bone marrow biopsy: fibrosis with collections of megakaryocytes
    Chromosomes - normal
    LAP- 130

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