Q. Should I get a bone marrow biopsy to rule out possible MPN?

Answered by
Dr. Matías
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 12, 2018

Hi doctor,

I am a 49-year-old female who has chronic health problems going back for awhile. Originally, I was told I had lupus but now I am beginning to think it is something else. Nine months back, I consulted an orthopedic surgeon due to suspected necrosis in left hip, after an arthrogram was done it revealed I had severe bone marrow inflammation in my si joint and was referred for a diagnosis of ankylosing spondylitis, that brings me to now. I have severe hip and leg pain, it aches constantly, severe fatigue and itching, bad headaches and migraines. I just feel like crap and I am not getting any better. I am on Plaquenil 200 mg daily, Duloxetine 60 mg, Monica, Dexamethasone as needed, usually three days a month, Oxycodone 30 mg as needed, Imitrex as needed. Not sure how to post a copy of my lab but my RBC is 5.3 but my MCH is low 26.9, my hematocrit is 44.2. My hs-CRP is high at 6.6. My calcium and protein are both borderline high. My ALT and bilirubin are also high. My UA shows high for ketones, WBC, leukocyte, esters and hyaline cast. I tested negative on the HLA-B27 DNA test. My sed rate was borderline high at 19, I was negative for Sjogren's antibody as well as sm and sm/RIP antibodies. At this point, I am not sure what is going on. Should I push for a bone marrow biopsy to rule out a possible MPN? I desperately want answers as to why I am in such pain and ill health.



Welcome to

I have checked your blood tests (attachment removed to protect patient identity) and read your complaints about your health. Apparently, you have a rheumatic disease. It does not seem to be lupus or rheumatoid arthritis at first sight according to the laboratory reports. In the MRI of the hip, it actually seems to be better than the last time. I saw that you may have a urinary tract infection according to the urinalysis you provided (do you have a burning sensation during urination). You should follow up with a rheumatologist to further characterize your pain. Regarding pruritus, there is some test that should be done. A sonogram of your liver and some laboratory reports as well to rule out hepatic disease, blood disorders, parasitic infections in your bowels, etc. You should also get an MRI of your brain and cervical spine for a better understanding of your headache.

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