A 55-year-old woman presents with anemia (Hb 7.2 g/dL), thrombocytopenia (platelets 48,000), and hepatosplenomegaly. Bone marrow biopsy shows 'dry tap' on aspiration. Trephine biopsy shows hypercellular marrow with reticulin fibrosis (grade MF-2) and abnormal megakaryocytes with cloud-like nuclei. JAK2 V617F is positive. The Dynamic International Prognostic Scoring System (DIPSS) category is determined by which parameters?

• A Age, hemoglobin, leukocyte count, constitutional symptoms, blasts in blood ✓
• B Age, platelet count, LDH, cytogenetics, blast percentage
• C Spleen size, JAK2 allele burden, transfusion dependence
• D Age, hemoglobin, leukocyte count, platelet count, and CALR vs JAK2 mutation

Explanation

DIPSS (Dynamic IPSS) for primary myelofibrosis uses 5 variables: age >65 years, hemoglobin <10 g/dL, leukocyte count >25×10⁹/L, constitutional symptoms, and circulating blasts ≥1%. Each item scores 1 point except anemia (scores 2 points in DIPSS). These are used to stratify patients into low, intermediate-1, intermediate-2, and high-risk categories driving treatment decisions. DIPSS-Plus adds platelet count <100×10⁹/L, RBC transfusion dependence, and unfavorable karyotype. Spleen size and JAK2 allele burden are not DIPSS parameters.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.