A 39-year-old woman has a persistently elevated platelet count of 690 × 10⁹/L on three occasions. JAK2 V617F mutation is detected. Examination shows mild splenomegaly. Haemoglobin and haematocrit are normal, and there is no history of thrombosis, bleeding, or significant cardiovascular risk factors. Bone marrow shows megakaryocytic proliferation without increased reticulin fibres. Most appropriate management?
- A Anagrelide as first-line cytoreduction
- B Hydroxyurea plus low-dose aspirin
- C Low-dose aspirin alone, without cytoreductive therapy ✓
- D Phlebotomy to keep haematocrit below 45 percent
Correct answer: C. Low-dose aspirin alone, without cytoreductive therapy
Explanation
She has essential thrombocythaemia (persistent thrombocytosis, JAK2 mutation, megakaryocytic proliferation, exclusion of reactive causes) and falls into the low-risk category because she is younger than 60 with no prior thrombosis. Low-risk patients receive low-dose aspirin alone; cytoreduction with hydroxyurea is reserved for high-risk patients (age over 60 or previous thrombosis). Anagrelide is second-line because of higher rates of arterial events and discontinuation. Phlebotomy treats polycythaemia vera, not thrombocythaemia.
Reference: Williams Hematology, 10th ed.
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