Myelofibrosis physical examination: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 4: Line 4:


==Overview==
==Overview==
Patients with myelofibrosis usually appear anemic. Physical examination of patients with myelofibrosis is usually remarkable for splenomegaly, hepatomegaly, skin pallor, petechiae and ecchymoses, and lymphoadenopathy.
[[Patient|Patients]] with [[myelofibrosis]] usually appear [[Anemia|anemic]]. [[Physical examination]] of [[Patient|patients]] with [[myelofibrosis]] is usually remarkable for [[splenomegaly]], [[hepatomegaly]], [[Pallor|skin pallor]], [[Petechia|petechiae]] and [[Bruise|ecchymoses]], and [[Lymphadenopathy|lymphoadenopathy]].


==Physical examination==   
==Physical examination==   
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with myelofibrosis usually appear anemic.
*[[Patient|Patients]] with [[myelofibrosis]] usually appear [[Anemia|anemic]].
===Vital Signs===
===Vital Signs===
*High to low grade fever<ref name="pmid26123310">{{cite journal |vauthors=Shinar Y, Tohami T, Livneh A, Schiby G, Hirshberg A, Nagar M, Goldstein I, Cohen R, Kukuy O, Shubman O, Sharabi Y, Gonzalez-Roca E, Arostegui JI, Rechavi G, Amariglio N, Salomon O |title=Acquired familial Mediterranean fever associated with a somatic MEFV mutation in a patient with JAK2 associated post-polycythemia myelofibrosis |journal=Orphanet J Rare Dis |volume=10 |issue= |pages=86 |date=June 2015 |pmid=26123310 |pmc=4506767 |doi=10.1186/s13023-015-0298-6 |url=}}</ref><ref name="pmid24403262">{{cite journal |vauthors=Mitra D, Kaye JA, Piecoro LT, Brown J, Reith K, Mughal TI, Sarlis NJ |title=Symptom burden and splenomegaly in patients with myelofibrosis in the United States: a retrospective medical record review |journal=Cancer Med |volume=2 |issue=6 |pages=889–98 |date=December 2013 |pmid=24403262 |pmc=3892393 |doi=10.1002/cam4.136 |url=}}</ref><ref name="pmid23684482">{{cite journal |vauthors=Mesa RA, Shields A, Hare T, Erickson-Viitanen S, Sun W, Sarlis NJ, Sandor V, Levy RS, Verstovsek S |title=Progressive burden of myelofibrosis in untreated patients: assessment of patient-reported outcomes in patients randomized to placebo in the COMFORT-I study |journal=Leuk. Res. |volume=37 |issue=8 |pages=911–6 |date=August 2013 |pmid=23684482 |doi=10.1016/j.leukres.2013.04.017 |url=}}</ref>
*High to low grade [[fever]]<ref name="pmid26123310">{{cite journal |vauthors=Shinar Y, Tohami T, Livneh A, Schiby G, Hirshberg A, Nagar M, Goldstein I, Cohen R, Kukuy O, Shubman O, Sharabi Y, Gonzalez-Roca E, Arostegui JI, Rechavi G, Amariglio N, Salomon O |title=Acquired familial Mediterranean fever associated with a somatic MEFV mutation in a patient with JAK2 associated post-polycythemia myelofibrosis |journal=Orphanet J Rare Dis |volume=10 |issue= |pages=86 |date=June 2015 |pmid=26123310 |pmc=4506767 |doi=10.1186/s13023-015-0298-6 |url=}}</ref><ref name="pmid24403262">{{cite journal |vauthors=Mitra D, Kaye JA, Piecoro LT, Brown J, Reith K, Mughal TI, Sarlis NJ |title=Symptom burden and splenomegaly in patients with myelofibrosis in the United States: a retrospective medical record review |journal=Cancer Med |volume=2 |issue=6 |pages=889–98 |date=December 2013 |pmid=24403262 |pmc=3892393 |doi=10.1002/cam4.136 |url=}}</ref><ref name="pmid23684482">{{cite journal |vauthors=Mesa RA, Shields A, Hare T, Erickson-Viitanen S, Sun W, Sarlis NJ, Sandor V, Levy RS, Verstovsek S |title=Progressive burden of myelofibrosis in untreated patients: assessment of patient-reported outcomes in patients randomized to placebo in the COMFORT-I study |journal=Leuk. Res. |volume=37 |issue=8 |pages=911–6 |date=August 2013 |pmid=23684482 |doi=10.1016/j.leukres.2013.04.017 |url=}}</ref>
*Tachypnea and tachycardia (if severely anemic)
*[[Tachypnea]] and [[tachycardia]] (if severely [[Anemia|anemic]])


===Skin===
===Skin===
*Petechiae and ecchymoses<ref name="pmid30405096">{{cite journal |vauthors=Finazzi G, Vannucchi AM, Barbui T |title=Prefibrotic myelofibrosis: treatment algorithm 2018 |journal=Blood Cancer J |volume=8 |issue=11 |pages=104 |date=November 2018 |pmid=30405096 |pmc=6221891 |doi=10.1038/s41408-018-0142-z |url=}}</ref><ref name="pmid29898956">{{cite journal |vauthors=Hofmann I, Geer MJ, Vögtle T, Crispin A, Campagna DR, Barr A, Calicchio ML, Heising S, van Geffen JP, Kuijpers MJE, Heemskerk JWM, Eble JA, Schmitz-Abe K, Obeng EA, Douglas M, Freson K, Pondarré C, Favier R, Jarvis GE, Markianos K, Turro E, Ouwehand WH, Mazharian A, Fleming MD, Senis YA |title=Congenital macrothrombocytopenia with focal myelofibrosis due to mutations in human G6b-B is rescued in humanized mice |journal=Blood |volume=132 |issue=13 |pages=1399–1412 |date=September 2018 |pmid=29898956 |doi=10.1182/blood-2017-08-802769 |url=}}</ref><ref name="pmid28808761">{{cite journal |vauthors=Kc D, Falchi L, Verstovsek S |title=The underappreciated risk of thrombosis and bleeding in patients with myelofibrosis: a review |journal=Ann. Hematol. |volume=96 |issue=10 |pages=1595–1604 |date=October 2017 |pmid=28808761 |pmc=5693670 |doi=10.1007/s00277-017-3099-2 |url=}}</ref><ref name=complmf1radio1>Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref>
*[[Petechia|Petechiae]] and [[Bruise|ecchymoses]]<ref name="pmid30405096">{{cite journal |vauthors=Finazzi G, Vannucchi AM, Barbui T |title=Prefibrotic myelofibrosis: treatment algorithm 2018 |journal=Blood Cancer J |volume=8 |issue=11 |pages=104 |date=November 2018 |pmid=30405096 |pmc=6221891 |doi=10.1038/s41408-018-0142-z |url=}}</ref><ref name="pmid29898956">{{cite journal |vauthors=Hofmann I, Geer MJ, Vögtle T, Crispin A, Campagna DR, Barr A, Calicchio ML, Heising S, van Geffen JP, Kuijpers MJE, Heemskerk JWM, Eble JA, Schmitz-Abe K, Obeng EA, Douglas M, Freson K, Pondarré C, Favier R, Jarvis GE, Markianos K, Turro E, Ouwehand WH, Mazharian A, Fleming MD, Senis YA |title=Congenital macrothrombocytopenia with focal myelofibrosis due to mutations in human G6b-B is rescued in humanized mice |journal=Blood |volume=132 |issue=13 |pages=1399–1412 |date=September 2018 |pmid=29898956 |doi=10.1182/blood-2017-08-802769 |url=}}</ref><ref name="pmid28808761">{{cite journal |vauthors=Kc D, Falchi L, Verstovsek S |title=The underappreciated risk of thrombosis and bleeding in patients with myelofibrosis: a review |journal=Ann. Hematol. |volume=96 |issue=10 |pages=1595–1604 |date=October 2017 |pmid=28808761 |pmc=5693670 |doi=10.1007/s00277-017-3099-2 |url=}}</ref><ref name="complmf1radio1">Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016</ref>
*Skin nodules<ref name="pmid18705835">{{cite journal |vauthors=Miyata T, Masuzawa M, Katsuoka K, Higashihara M |title=Cutaneous extramedullary hematopoiesis in a patient with idiopathic myelofibrosis |journal=J. Dermatol. |volume=35 |issue=7 |pages=456–61 |date=July 2008 |pmid=18705835 |doi=10.1111/j.1346-8138.2008.00502.x |url=}}</ref><ref name="pmid18394406">{{cite journal |vauthors=Corella F, Barnadas MA, Bordes R, Curell R, Espinosa I, Vergara C, Alomar A |title=[A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis] |language=Spanish; Castilian |journal=Actas Dermosifiliogr |volume=99 |issue=4 |pages=297–300 |date=May 2008 |pmid=18394406 |doi= |url=}}</ref><ref name="pmid10405485">{{cite journal |vauthors=Kwon KS, Lee JB, Jang HS, Chung TA, Oh CK |title=A case of cutaneous extramedullary hematopoiesis in myelofibrosis with a preponderance of eosinophilic precursor cells |journal=J. Dermatol. |volume=26 |issue=6 |pages=379–84 |date=June 1999 |pmid=10405485 |doi= |url=}}</ref><ref name="pmid7784946">{{cite journal |vauthors=Ruberto E, Espinola R, Brusco J, Bacchiocchi M, Zoppi J, Paz R |title=[Idiopathic myelofibrosis with extramedullary hematopoiesis foci in the skin and testicles. Report of a case] |language=Spanish; Castilian |journal=Sangre (Barc) |volume=40 |issue=2 |pages=157–60 |date=April 1995 |pmid=7784946 |doi= |url=}}</ref>
*[[Skin nodules]]<ref name="pmid18705835">{{cite journal |vauthors=Miyata T, Masuzawa M, Katsuoka K, Higashihara M |title=Cutaneous extramedullary hematopoiesis in a patient with idiopathic myelofibrosis |journal=J. Dermatol. |volume=35 |issue=7 |pages=456–61 |date=July 2008 |pmid=18705835 |doi=10.1111/j.1346-8138.2008.00502.x |url=}}</ref><ref name="pmid18394406">{{cite journal |vauthors=Corella F, Barnadas MA, Bordes R, Curell R, Espinosa I, Vergara C, Alomar A |title=[A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis] |language=Spanish; Castilian |journal=Actas Dermosifiliogr |volume=99 |issue=4 |pages=297–300 |date=May 2008 |pmid=18394406 |doi= |url=}}</ref><ref name="pmid10405485">{{cite journal |vauthors=Kwon KS, Lee JB, Jang HS, Chung TA, Oh CK |title=A case of cutaneous extramedullary hematopoiesis in myelofibrosis with a preponderance of eosinophilic precursor cells |journal=J. Dermatol. |volume=26 |issue=6 |pages=379–84 |date=June 1999 |pmid=10405485 |doi= |url=}}</ref><ref name="pmid7784946">{{cite journal |vauthors=Ruberto E, Espinola R, Brusco J, Bacchiocchi M, Zoppi J, Paz R |title=[Idiopathic myelofibrosis with extramedullary hematopoiesis foci in the skin and testicles. Report of a case] |language=Spanish; Castilian |journal=Sangre (Barc) |volume=40 |issue=2 |pages=157–60 |date=April 1995 |pmid=7784946 |doi= |url=}}</ref>
*Pallor<ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>
*[[Pallor]]<ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>


===HEENT===
===HEENT===
*Lymphadenopathy which may involve the head and neck<ref name="pmid28011890">{{cite journal |vauthors=Panda A, Chandrashekhara SH, Nambirajan A, Mishra P |title=Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=December 2016 |pmid=28011890 |doi=10.1136/bcr-2016-217854 |url=}}</ref><ref name="pmid28781273">{{cite journal |vauthors=Sakatoku K, Takeoka Y, Araki T, Miura A, Fujitani Y, Yamamura R, Miyagi Y, Senzaki H, Ohta K |title=Lymphocyte-depleted classical Hodgkin lymphoma accompanied by myelofibrosis |language=Japanese |journal=Rinsho Ketsueki |volume=58 |issue=7 |pages=772–775 |date=2017 |pmid=28781273 |doi=10.11406/rinketsu.58.772 |url=}}</ref><ref name="pmid30046414">{{cite journal |vauthors=Aljabry MS, Asiri S, Elsafi T, Elyamany G |title=Generalized lymphadenopathy secondary to isolated extramedullary hematopoiesis as an initial manifestation of primary myelofibrosis |journal=Hematol Rep |volume=10 |issue=2 |pages=7588 |date=May 2018 |pmid=30046414 |pmc=6036984 |doi=10.4081/hr.2018.7588 |url=}}</ref>
*[[Lymphadenopathy]] which may involve the [[head]] and [[neck]]<ref name="pmid28011890">{{cite journal |vauthors=Panda A, Chandrashekhara SH, Nambirajan A, Mishra P |title=Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=December 2016 |pmid=28011890 |doi=10.1136/bcr-2016-217854 |url=}}</ref><ref name="pmid28781273">{{cite journal |vauthors=Sakatoku K, Takeoka Y, Araki T, Miura A, Fujitani Y, Yamamura R, Miyagi Y, Senzaki H, Ohta K |title=Lymphocyte-depleted classical Hodgkin lymphoma accompanied by myelofibrosis |language=Japanese |journal=Rinsho Ketsueki |volume=58 |issue=7 |pages=772–775 |date=2017 |pmid=28781273 |doi=10.11406/rinketsu.58.772 |url=}}</ref><ref name="pmid30046414">{{cite journal |vauthors=Aljabry MS, Asiri S, Elsafi T, Elyamany G |title=Generalized lymphadenopathy secondary to isolated extramedullary hematopoiesis as an initial manifestation of primary myelofibrosis |journal=Hematol Rep |volume=10 |issue=2 |pages=7588 |date=May 2018 |pmid=30046414 |pmc=6036984 |doi=10.4081/hr.2018.7588 |url=}}</ref>
*Signs of jaundice<ref name="pmid2251548">{{cite journal |vauthors=Meshchaninova ON |title=[A case of osteomyelofibrosis with jaundice] |language=Russian |journal=Sov Med |volume= |issue=7 |pages=107–8 |date=1990 |pmid=2251548 |doi= |url=}}</ref><ref name="pmid21162885">{{cite journal |vauthors=Song ZQ, Zhou LY |title=[A clinical analysis of six cases of portal hypertension secondary to primary myelofibrosis and review of literatures] |language=Chinese |journal=Zhonghua Nei Ke Za Zhi |volume=49 |issue=10 |pages=845–7 |date=October 2010 |pmid=21162885 |doi= |url=}}</ref><ref name="pmid1887177">{{cite journal |vauthors=Saad GM, de Almeida TV |title=[Idiopathic myelofibrosis] |language=Portuguese |journal=Rev Paul Med |volume=109 |issue=2 |pages=47–50 |date=1991 |pmid=1887177 |doi= |url=}}</ref><ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>
*Signs of [[jaundice]]<ref name="pmid2251548">{{cite journal |vauthors=Meshchaninova ON |title=[A case of osteomyelofibrosis with jaundice] |language=Russian |journal=Sov Med |volume= |issue=7 |pages=107–8 |date=1990 |pmid=2251548 |doi= |url=}}</ref><ref name="pmid21162885">{{cite journal |vauthors=Song ZQ, Zhou LY |title=[A clinical analysis of six cases of portal hypertension secondary to primary myelofibrosis and review of literatures] |language=Chinese |journal=Zhonghua Nei Ke Za Zhi |volume=49 |issue=10 |pages=845–7 |date=October 2010 |pmid=21162885 |doi= |url=}}</ref><ref name="pmid1887177">{{cite journal |vauthors=Saad GM, de Almeida TV |title=[Idiopathic myelofibrosis] |language=Portuguese |journal=Rev Paul Med |volume=109 |issue=2 |pages=47–50 |date=1991 |pmid=1887177 |doi= |url=}}</ref><ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>
===Neck===
===Neck===
*Lymphadenopathy<ref name="pmid28011890">{{cite journal |vauthors=Panda A, Chandrashekhara SH, Nambirajan A, Mishra P |title=Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=December 2016 |pmid=28011890 |doi=10.1136/bcr-2016-217854 |url=}}</ref><ref name="pmid28781273">{{cite journal |vauthors=Sakatoku K, Takeoka Y, Araki T, Miura A, Fujitani Y, Yamamura R, Miyagi Y, Senzaki H, Ohta K |title=Lymphocyte-depleted classical Hodgkin lymphoma accompanied by myelofibrosis |language=Japanese |journal=Rinsho Ketsueki |volume=58 |issue=7 |pages=772–775 |date=2017 |pmid=28781273 |doi=10.11406/rinketsu.58.772 |url=}}</ref><ref name="pmid30046414">{{cite journal |vauthors=Aljabry MS, Asiri S, Elsafi T, Elyamany G |title=Generalized lymphadenopathy secondary to isolated extramedullary hematopoiesis as an initial manifestation of primary myelofibrosis |journal=Hematol Rep |volume=10 |issue=2 |pages=7588 |date=May 2018 |pmid=30046414 |pmc=6036984 |doi=10.4081/hr.2018.7588 |url=}}</ref>
*[[Lymphadenopathy]]<ref name="pmid28011890">{{cite journal |vauthors=Panda A, Chandrashekhara SH, Nambirajan A, Mishra P |title=Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up |journal=BMJ Case Rep |volume=2016 |issue= |pages= |date=December 2016 |pmid=28011890 |doi=10.1136/bcr-2016-217854 |url=}}</ref><ref name="pmid28781273">{{cite journal |vauthors=Sakatoku K, Takeoka Y, Araki T, Miura A, Fujitani Y, Yamamura R, Miyagi Y, Senzaki H, Ohta K |title=Lymphocyte-depleted classical Hodgkin lymphoma accompanied by myelofibrosis |language=Japanese |journal=Rinsho Ketsueki |volume=58 |issue=7 |pages=772–775 |date=2017 |pmid=28781273 |doi=10.11406/rinketsu.58.772 |url=}}</ref><ref name="pmid30046414">{{cite journal |vauthors=Aljabry MS, Asiri S, Elsafi T, Elyamany G |title=Generalized lymphadenopathy secondary to isolated extramedullary hematopoiesis as an initial manifestation of primary myelofibrosis |journal=Hematol Rep |volume=10 |issue=2 |pages=7588 |date=May 2018 |pmid=30046414 |pmc=6036984 |doi=10.4081/hr.2018.7588 |url=}}</ref>
===Lungs===
===Lungs===
*Pulmonary examination of patients with myelofibrosis is usually normal.
*[[Lung|Pulmonary]] examination of [[patients]] with [[myelofibrosis]] is usually normal.
===Heart===
===Heart===
*Cardiovascular examination of patients with myelofibrosis is usually normal.
*[[Cardiovascular]] examination of [[patients]] with [[myelofibrosis]] is usually normal.
===Abdomen===
===Abdomen===
*Splenomegaly<ref name="pmid27521149">{{cite journal |vauthors=Pizzi M, Gergis U, Chaviano F, Orazi A |title=The effects of hematopoietic stem cell transplant on splenic extramedullary hematopoiesis in patients with myeloproliferative neoplasm-associated myelofibrosis |journal=Hematol Oncol Stem Cell Ther |volume=9 |issue=3 |pages=96–104 |date=September 2016 |pmid=27521149 |doi=10.1016/j.hemonc.2016.07.002 |url=}}</ref>
*[[Splenomegaly]]<ref name="pmid27521149">{{cite journal |vauthors=Pizzi M, Gergis U, Chaviano F, Orazi A |title=The effects of hematopoietic stem cell transplant on splenic extramedullary hematopoiesis in patients with myeloproliferative neoplasm-associated myelofibrosis |journal=Hematol Oncol Stem Cell Ther |volume=9 |issue=3 |pages=96–104 |date=September 2016 |pmid=27521149 |doi=10.1016/j.hemonc.2016.07.002 |url=}}</ref>
*Hepatomegaly<ref name="pmid26885416">{{cite journal |vauthors=Mohyuddin GR, Yacoub A |title=Primary Myelofibrosis Presenting as Extramedullary Hematopoiesis in a Transplanted Liver Graft: Case Report and Review of the Literature |journal=Case Rep Hematol |volume=2016 |issue= |pages=9515404 |date=2016 |pmid=26885416 |pmc=4739215 |doi=10.1155/2016/9515404 |url=}}</ref><ref name="pmid23619118">{{cite journal |vauthors=Henry M, Chitlur M, Rajpurkar M, Mastropietro CW, Poulik J, Ravindranath Y |title=Myelofibrosis, hepatic extramedullary hematopoiesis and ascites associated with vitamin D deficiency in early infancy |journal=J. Pediatr. Hematol. Oncol. |volume=36 |issue=4 |pages=319–21 |date=May 2014 |pmid=23619118 |doi=10.1097/MPH.0b013e31828e548a |url=}}</ref>
*[[Hepatomegaly]]<ref name="pmid26885416">{{cite journal |vauthors=Mohyuddin GR, Yacoub A |title=Primary Myelofibrosis Presenting as Extramedullary Hematopoiesis in a Transplanted Liver Graft: Case Report and Review of the Literature |journal=Case Rep Hematol |volume=2016 |issue= |pages=9515404 |date=2016 |pmid=26885416 |pmc=4739215 |doi=10.1155/2016/9515404 |url=}}</ref><ref name="pmid23619118">{{cite journal |vauthors=Henry M, Chitlur M, Rajpurkar M, Mastropietro CW, Poulik J, Ravindranath Y |title=Myelofibrosis, hepatic extramedullary hematopoiesis and ascites associated with vitamin D deficiency in early infancy |journal=J. Pediatr. Hematol. Oncol. |volume=36 |issue=4 |pages=319–21 |date=May 2014 |pmid=23619118 |doi=10.1097/MPH.0b013e31828e548a |url=}}</ref>
*Abdominal distension<ref name="pmid25206301">{{cite journal |vauthors=Wei XQ, Zheng ZH, Jin Y, Tao J, Abassa KK, Wen ZF, Shao CK, Wei HB, Wu B |title=Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis |journal=World J. Gastroenterol. |volume=20 |issue=33 |pages=11921–6 |date=September 2014 |pmid=25206301 |pmc=4155387 |doi=10.3748/wjg.v20.i33.11921 |url=}}</ref>
*[[Abdominal distension]]<ref name="pmid25206301">{{cite journal |vauthors=Wei XQ, Zheng ZH, Jin Y, Tao J, Abassa KK, Wen ZF, Shao CK, Wei HB, Wu B |title=Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis |journal=World J. Gastroenterol. |volume=20 |issue=33 |pages=11921–6 |date=September 2014 |pmid=25206301 |pmc=4155387 |doi=10.3748/wjg.v20.i33.11921 |url=}}</ref>
===Back===
===Back===
*Back examination in patients with myelofibrosis is usually normal.
*[[Back]] examination in [[patients]] with [[myelofibrosis]] is usually normal.
===Genitourinary===
===Genitourinary===
*Genitourinary examination of patients with myelofibrosis is usually normal.
*[[Genitourinary]] examination of [[patients]] with [[myelofibrosis]] is usually normal.
===Neuromuscular===
===Neuromuscular===
*Neuromuscular examination in patients with myelifibrosis is usually normal unless the extramedullary hematopoiesis involves the central nervous system in which case, neurological manifestations will be present.<ref name="pmid23621819">{{cite journal |vauthors=Singer A, Quencer R |title=Intracranial extramedullary hematopoiesis: a rare cause of headaches |journal=J Neuroimaging |volume=24 |issue=5 |pages=524–7 |date=2014 |pmid=23621819 |doi=10.1111/jon.12029 |url=}}</ref><ref name="pmid28775247">{{cite journal |vauthors=Fareed S, Nashwan AJ, Abu Jarir S, Husain A, Suliman DS, Ibrahim F, Moustafa A, Akhter MS, Yassin MA |title=Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis |journal=Am J Case Rep |volume=18 |issue= |pages=859–864 |date=August 2017 |pmid=28775247 |pmc=5551928 |doi= |url=}}</ref><ref name="pmid24429645">{{cite journal |vauthors=Hijikata Y, Ando T, Inagaki T, Watanabe H, Ito M, Sobue G |title=[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis] |language=Japanese |journal=Rinsho Shinkeigaku |volume=54 |issue=1 |pages=27–31 |date=2014 |pmid=24429645 |doi= |url=}}</ref><ref name="pmid11843900">{{cite journal |vauthors=Mak YK, Chan CH, So CC, Chan MK, Chu YC |title=Idiopathic myelofibrosis with extramedullary haemopoiesis involving the urinary bladder in a Chinese lady |journal=Clin Lab Haematol |volume=24 |issue=1 |pages=55–9 |date=February 2002 |pmid=11843900 |doi= |url=}}</ref><ref name="pmid28775247">{{cite journal |vauthors=Fareed S, Nashwan AJ, Abu Jarir S, Husain A, Suliman DS, Ibrahim F, Moustafa A, Akhter MS, Yassin MA |title=Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis |journal=Am J Case Rep |volume=18 |issue= |pages=859–864 |date=August 2017 |pmid=28775247 |pmc=5551928 |doi= |url=}}</ref><ref name="pmid24429645">{{cite journal |vauthors=Hijikata Y, Ando T, Inagaki T, Watanabe H, Ito M, Sobue G |title=[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis] |language=Japanese |journal=Rinsho Shinkeigaku |volume=54 |issue=1 |pages=27–31 |date=2014 |pmid=24429645 |doi= |url=}}</ref><ref name="pmid20534957">{{cite journal |vauthors=Kawasaki Y, Nakazora T, Suzukawa M, Tominaga T, Wang ZK, Shinohara K |title=[Neurological disturbance of the lower extremities by an extramedullary hematopoietic mass complicated with primary myelofibrosis] |language=Japanese |journal=Rinsho Ketsueki |volume=51 |issue=5 |pages=349–52 |date=May 2010 |pmid=20534957 |doi= |url=}}</ref><ref name="pmid18441161">{{cite journal |vauthors=Scott IC, Poynton CH |title=Polycythaemia rubra vera and myelofibrosis with spinal cord compression |journal=J. Clin. Pathol. |volume=61 |issue=5 |pages=681–3 |date=May 2008 |pmid=18441161 |doi=10.1136/jcp.2007.053751 |url=}}</ref><ref name="pmid16440779">{{cite journal |vauthors=Ohnishi K, Torimoto Y, Itabashi K, Inamura J, Shindo M, Ikuta K, Sato K, Kohgo Y |title=[Case of intraspinal epidural tumor developing after systemic mastocytosis with marked osteosclerosis and myelofibrosis] |language=Japanese |journal=Rinsho Ketsueki |volume=46 |issue=10 |pages=1146–51 |date=October 2005 |pmid=16440779 |doi= |url=}}</ref><ref name="pmid12365470">{{cite journal |vauthors=de Haas KP, van de Loosdrecht AA, Daenen SM |title=Intraspinal extramedullary haematopoiesis in a patient with myelofibrosis |journal=Neth J Med |volume=60 |issue=6 |pages=256–9 |date=July 2002 |pmid=12365470 |doi= |url=}}</ref><ref name="pmid8027402">{{cite journal |vauthors=Cook G, Sharp RA |title=Spinal cord compression due to extramedullary haemopoiesis in myelofibrosis |journal=J. Clin. Pathol. |volume=47 |issue=5 |pages=464–5 |date=May 1994 |pmid=8027402 |pmc=502028 |doi= |url=}}</ref>
*[[Neuromuscular]] examination in [[patients]] with [[myelofibrosis]] is usually normal unless the [[Extramedullary hematopoiesis|extramedullary hematopoiesis (EMH)]] involves the [[Central nervous system|central nervous system (CNS)]] in which case, [[Neurology|neurological]] manifestations will be present.<ref name="pmid23621819">{{cite journal |vauthors=Singer A, Quencer R |title=Intracranial extramedullary hematopoiesis: a rare cause of headaches |journal=J Neuroimaging |volume=24 |issue=5 |pages=524–7 |date=2014 |pmid=23621819 |doi=10.1111/jon.12029 |url=}}</ref><ref name="pmid28775247">{{cite journal |vauthors=Fareed S, Nashwan AJ, Abu Jarir S, Husain A, Suliman DS, Ibrahim F, Moustafa A, Akhter MS, Yassin MA |title=Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis |journal=Am J Case Rep |volume=18 |issue= |pages=859–864 |date=August 2017 |pmid=28775247 |pmc=5551928 |doi= |url=}}</ref><ref name="pmid24429645">{{cite journal |vauthors=Hijikata Y, Ando T, Inagaki T, Watanabe H, Ito M, Sobue G |title=[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis] |language=Japanese |journal=Rinsho Shinkeigaku |volume=54 |issue=1 |pages=27–31 |date=2014 |pmid=24429645 |doi= |url=}}</ref><ref name="pmid11843900">{{cite journal |vauthors=Mak YK, Chan CH, So CC, Chan MK, Chu YC |title=Idiopathic myelofibrosis with extramedullary haemopoiesis involving the urinary bladder in a Chinese lady |journal=Clin Lab Haematol |volume=24 |issue=1 |pages=55–9 |date=February 2002 |pmid=11843900 |doi= |url=}}</ref><ref name="pmid28775247">{{cite journal |vauthors=Fareed S, Nashwan AJ, Abu Jarir S, Husain A, Suliman DS, Ibrahim F, Moustafa A, Akhter MS, Yassin MA |title=Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis |journal=Am J Case Rep |volume=18 |issue= |pages=859–864 |date=August 2017 |pmid=28775247 |pmc=5551928 |doi= |url=}}</ref><ref name="pmid24429645">{{cite journal |vauthors=Hijikata Y, Ando T, Inagaki T, Watanabe H, Ito M, Sobue G |title=[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis] |language=Japanese |journal=Rinsho Shinkeigaku |volume=54 |issue=1 |pages=27–31 |date=2014 |pmid=24429645 |doi= |url=}}</ref><ref name="pmid20534957">{{cite journal |vauthors=Kawasaki Y, Nakazora T, Suzukawa M, Tominaga T, Wang ZK, Shinohara K |title=[Neurological disturbance of the lower extremities by an extramedullary hematopoietic mass complicated with primary myelofibrosis] |language=Japanese |journal=Rinsho Ketsueki |volume=51 |issue=5 |pages=349–52 |date=May 2010 |pmid=20534957 |doi= |url=}}</ref><ref name="pmid18441161">{{cite journal |vauthors=Scott IC, Poynton CH |title=Polycythaemia rubra vera and myelofibrosis with spinal cord compression |journal=J. Clin. Pathol. |volume=61 |issue=5 |pages=681–3 |date=May 2008 |pmid=18441161 |doi=10.1136/jcp.2007.053751 |url=}}</ref><ref name="pmid16440779">{{cite journal |vauthors=Ohnishi K, Torimoto Y, Itabashi K, Inamura J, Shindo M, Ikuta K, Sato K, Kohgo Y |title=[Case of intraspinal epidural tumor developing after systemic mastocytosis with marked osteosclerosis and myelofibrosis] |language=Japanese |journal=Rinsho Ketsueki |volume=46 |issue=10 |pages=1146–51 |date=October 2005 |pmid=16440779 |doi= |url=}}</ref><ref name="pmid12365470">{{cite journal |vauthors=de Haas KP, van de Loosdrecht AA, Daenen SM |title=Intraspinal extramedullary haematopoiesis in a patient with myelofibrosis |journal=Neth J Med |volume=60 |issue=6 |pages=256–9 |date=July 2002 |pmid=12365470 |doi= |url=}}</ref><ref name="pmid8027402">{{cite journal |vauthors=Cook G, Sharp RA |title=Spinal cord compression due to extramedullary haemopoiesis in myelofibrosis |journal=J. Clin. Pathol. |volume=47 |issue=5 |pages=464–5 |date=May 1994 |pmid=8027402 |pmc=502028 |doi= |url=}}</ref>
===Extremities===
===Extremities===
*Clubbing<ref name="pmid18038138">{{cite journal |vauthors=Saghafi M, Azarian A, Nohesara N |title=Primary hypertrophic osteoarthropathy with myelofibrosis |journal=Rheumatol. Int. |volume=28 |issue=6 |pages=597–600 |date=April 2008 |pmid=18038138 |doi=10.1007/s00296-007-0477-4 |url=}}</ref><ref name="pmid22715563">{{cite journal |vauthors=Pandita KK, Afaq S, Singh D, Mushtaq D, Masood I |title=Finger clubbing in a patient of myelofibrosis with renal cell carcinoma |journal=J Assoc Physicians India |volume=60 |issue= |pages=124–6 |date=February 2012 |pmid=22715563 |doi= |url=}}</ref>
*[[Clubbing]]<ref name="pmid18038138">{{cite journal |vauthors=Saghafi M, Azarian A, Nohesara N |title=Primary hypertrophic osteoarthropathy with myelofibrosis |journal=Rheumatol. Int. |volume=28 |issue=6 |pages=597–600 |date=April 2008 |pmid=18038138 |doi=10.1007/s00296-007-0477-4 |url=}}</ref><ref name="pmid22715563">{{cite journal |vauthors=Pandita KK, Afaq S, Singh D, Mushtaq D, Masood I |title=Finger clubbing in a patient of myelofibrosis with renal cell carcinoma |journal=J Assoc Physicians India |volume=60 |issue= |pages=124–6 |date=February 2012 |pmid=22715563 |doi= |url=}}</ref>
*Edema<ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>
*[[Edema]]<ref>{{cite book | last = Hoffman | first = Ronald | title = Hematology : basic principles and practice | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 9780323357623 }}</ref>


==References==
==References==

Revision as of 20:44, 11 December 2018

Myelofibrosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Myelofibrosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Myelofibrosis physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Myelofibrosis physical examination

All Images
X-rays
Echo and Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Myelofibrosis physical examination

CDC on Myelofibrosis physical examination

Myelofibrosis physical examination in the news

Blogs on Myelofibrosis physical examination

Directions to Hospitals Treating Myelofibrosis

Risk calculators and risk factors for Myelofibrosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Patients with myelofibrosis usually appear anemic. Physical examination of patients with myelofibrosis is usually remarkable for splenomegaly, hepatomegaly, skin pallor, petechiae and ecchymoses, and lymphoadenopathy.

Physical examination

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Shinar Y, Tohami T, Livneh A, Schiby G, Hirshberg A, Nagar M, Goldstein I, Cohen R, Kukuy O, Shubman O, Sharabi Y, Gonzalez-Roca E, Arostegui JI, Rechavi G, Amariglio N, Salomon O (June 2015). "Acquired familial Mediterranean fever associated with a somatic MEFV mutation in a patient with JAK2 associated post-polycythemia myelofibrosis". Orphanet J Rare Dis. 10: 86. doi:10.1186/s13023-015-0298-6. PMC 4506767. PMID 26123310.
  2. ↑ Mitra D, Kaye JA, Piecoro LT, Brown J, Reith K, Mughal TI, Sarlis NJ (December 2013). "Symptom burden and splenomegaly in patients with myelofibrosis in the United States: a retrospective medical record review". Cancer Med. 2 (6): 889–98. doi:10.1002/cam4.136. PMC 3892393. PMID 24403262.
  3. ↑ Mesa RA, Shields A, Hare T, Erickson-Viitanen S, Sun W, Sarlis NJ, Sandor V, Levy RS, Verstovsek S (August 2013). "Progressive burden of myelofibrosis in untreated patients: assessment of patient-reported outcomes in patients randomized to placebo in the COMFORT-I study". Leuk. Res. 37 (8): 911–6. doi:10.1016/j.leukres.2013.04.017. PMID 23684482.
  4. ↑ Finazzi G, Vannucchi AM, Barbui T (November 2018). "Prefibrotic myelofibrosis: treatment algorithm 2018". Blood Cancer J. 8 (11): 104. doi:10.1038/s41408-018-0142-z. PMC 6221891. PMID 30405096.
  5. ↑ Hofmann I, Geer MJ, Vögtle T, Crispin A, Campagna DR, Barr A, Calicchio ML, Heising S, van Geffen JP, Kuijpers M, Heemskerk J, Eble JA, Schmitz-Abe K, Obeng EA, Douglas M, Freson K, Pondarré C, Favier R, Jarvis GE, Markianos K, Turro E, Ouwehand WH, Mazharian A, Fleming MD, Senis YA (September 2018). "Congenital macrothrombocytopenia with focal myelofibrosis due to mutations in human G6b-B is rescued in humanized mice". Blood. 132 (13): 1399–1412. doi:10.1182/blood-2017-08-802769. PMID 29898956. Vancouver style error: initials (help)
  6. ↑ Kc D, Falchi L, Verstovsek S (October 2017). "The underappreciated risk of thrombosis and bleeding in patients with myelofibrosis: a review". Ann. Hematol. 96 (10): 1595–1604. doi:10.1007/s00277-017-3099-2. PMC 5693670. PMID 28808761.
  7. ↑ Complications of primary myelofibrosis. Dr Henry Knipe and Dr Yuranga Weerakkody et al. Radiopaedia 2016. http://radiopaedia.org/articles/myelofibrosis. Accessed on March 10, 2016
  8. ↑ Miyata T, Masuzawa M, Katsuoka K, Higashihara M (July 2008). "Cutaneous extramedullary hematopoiesis in a patient with idiopathic myelofibrosis". J. Dermatol. 35 (7): 456–61. doi:10.1111/j.1346-8138.2008.00502.x. PMID 18705835.
  9. ↑ Corella F, Barnadas MA, Bordes R, Curell R, Espinosa I, Vergara C, Alomar A (May 2008). "[A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis]". Actas Dermosifiliogr (in Spanish; Castilian). 99 (4): 297–300. PMID 18394406.
  10. ↑ Kwon KS, Lee JB, Jang HS, Chung TA, Oh CK (June 1999). "A case of cutaneous extramedullary hematopoiesis in myelofibrosis with a preponderance of eosinophilic precursor cells". J. Dermatol. 26 (6): 379–84. PMID 10405485.
  11. ↑ Ruberto E, Espinola R, Brusco J, Bacchiocchi M, Zoppi J, Paz R (April 1995). "[Idiopathic myelofibrosis with extramedullary hematopoiesis foci in the skin and testicles. Report of a case]". Sangre (Barc) (in Spanish; Castilian). 40 (2): 157–60. PMID 7784946.
  12. ↑ Hoffman, Ronald (2018). Hematology : basic principles and practice. Philadelphia, PA: Elsevier. ISBN 9780323357623.
  13. ↑ 13.0 13.1 Panda A, Chandrashekhara SH, Nambirajan A, Mishra P (December 2016). "Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up". BMJ Case Rep. 2016. doi:10.1136/bcr-2016-217854. PMID 28011890.
  14. ↑ 14.0 14.1 Sakatoku K, Takeoka Y, Araki T, Miura A, Fujitani Y, Yamamura R, Miyagi Y, Senzaki H, Ohta K (2017). "Lymphocyte-depleted classical Hodgkin lymphoma accompanied by myelofibrosis". Rinsho Ketsueki (in Japanese). 58 (7): 772–775. doi:10.11406/rinketsu.58.772. PMID 28781273.
  15. ↑ 15.0 15.1 Aljabry MS, Asiri S, Elsafi T, Elyamany G (May 2018). "Generalized lymphadenopathy secondary to isolated extramedullary hematopoiesis as an initial manifestation of primary myelofibrosis". Hematol Rep. 10 (2): 7588. doi:10.4081/hr.2018.7588. PMC 6036984. PMID 30046414.
  16. ↑ Meshchaninova ON (1990). "[A case of osteomyelofibrosis with jaundice]". Sov Med (in Russian) (7): 107–8. PMID 2251548.
  17. ↑ Song ZQ, Zhou LY (October 2010). "[A clinical analysis of six cases of portal hypertension secondary to primary myelofibrosis and review of literatures]". Zhonghua Nei Ke Za Zhi (in Chinese). 49 (10): 845–7. PMID 21162885.
  18. ↑ Saad GM, de Almeida TV (1991). "[Idiopathic myelofibrosis]". Rev Paul Med (in Portuguese). 109 (2): 47–50. PMID 1887177.
  19. ↑ Hoffman, Ronald (2018). Hematology : basic principles and practice. Philadelphia, PA: Elsevier. ISBN 9780323357623.
  20. ↑ Pizzi M, Gergis U, Chaviano F, Orazi A (September 2016). "The effects of hematopoietic stem cell transplant on splenic extramedullary hematopoiesis in patients with myeloproliferative neoplasm-associated myelofibrosis". Hematol Oncol Stem Cell Ther. 9 (3): 96–104. doi:10.1016/j.hemonc.2016.07.002. PMID 27521149.
  21. ↑ Mohyuddin GR, Yacoub A (2016). "Primary Myelofibrosis Presenting as Extramedullary Hematopoiesis in a Transplanted Liver Graft: Case Report and Review of the Literature". Case Rep Hematol. 2016: 9515404. doi:10.1155/2016/9515404. PMC 4739215. PMID 26885416.
  22. ↑ Henry M, Chitlur M, Rajpurkar M, Mastropietro CW, Poulik J, Ravindranath Y (May 2014). "Myelofibrosis, hepatic extramedullary hematopoiesis and ascites associated with vitamin D deficiency in early infancy". J. Pediatr. Hematol. Oncol. 36 (4): 319–21. doi:10.1097/MPH.0b013e31828e548a. PMID 23619118.
  23. ↑ Wei XQ, Zheng ZH, Jin Y, Tao J, Abassa KK, Wen ZF, Shao CK, Wei HB, Wu B (September 2014). "Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis". World J. Gastroenterol. 20 (33): 11921–6. doi:10.3748/wjg.v20.i33.11921. PMC 4155387. PMID 25206301.
  24. ↑ Singer A, Quencer R (2014). "Intracranial extramedullary hematopoiesis: a rare cause of headaches". J Neuroimaging. 24 (5): 524–7. doi:10.1111/jon.12029. PMID 23621819.
  25. ↑ 25.0 25.1 Fareed S, Nashwan AJ, Abu Jarir S, Husain A, Suliman DS, Ibrahim F, Moustafa A, Akhter MS, Yassin MA (August 2017). "Spinal Abscess Caused by Salmonella Bacteremia in a Patient with Primary Myelofibrosis". Am J Case Rep. 18: 859–864. PMC 5551928. PMID 28775247.
  26. ↑ 26.0 26.1 Hijikata Y, Ando T, Inagaki T, Watanabe H, Ito M, Sobue G (2014). "[Spinal cord compression due to extramedullary hematopoiesis in a patient with myelofibrosis]". Rinsho Shinkeigaku (in Japanese). 54 (1): 27–31. PMID 24429645.
  27. ↑ Mak YK, Chan CH, So CC, Chan MK, Chu YC (February 2002). "Idiopathic myelofibrosis with extramedullary haemopoiesis involving the urinary bladder in a Chinese lady". Clin Lab Haematol. 24 (1): 55–9. PMID 11843900.
  28. ↑ Kawasaki Y, Nakazora T, Suzukawa M, Tominaga T, Wang ZK, Shinohara K (May 2010). "[Neurological disturbance of the lower extremities by an extramedullary hematopoietic mass complicated with primary myelofibrosis]". Rinsho Ketsueki (in Japanese). 51 (5): 349–52. PMID 20534957.
  29. ↑ Scott IC, Poynton CH (May 2008). "Polycythaemia rubra vera and myelofibrosis with spinal cord compression". J. Clin. Pathol. 61 (5): 681–3. doi:10.1136/jcp.2007.053751. PMID 18441161.
  30. ↑ Ohnishi K, Torimoto Y, Itabashi K, Inamura J, Shindo M, Ikuta K, Sato K, Kohgo Y (October 2005). "[Case of intraspinal epidural tumor developing after systemic mastocytosis with marked osteosclerosis and myelofibrosis]". Rinsho Ketsueki (in Japanese). 46 (10): 1146–51. PMID 16440779.
  31. ↑ de Haas KP, van de Loosdrecht AA, Daenen SM (July 2002). "Intraspinal extramedullary haematopoiesis in a patient with myelofibrosis". Neth J Med. 60 (6): 256–9. PMID 12365470.
  32. ↑ Cook G, Sharp RA (May 1994). "Spinal cord compression due to extramedullary haemopoiesis in myelofibrosis". J. Clin. Pathol. 47 (5): 464–5. PMC 502028. PMID 8027402.
  33. ↑ Saghafi M, Azarian A, Nohesara N (April 2008). "Primary hypertrophic osteoarthropathy with myelofibrosis". Rheumatol. Int. 28 (6): 597–600. doi:10.1007/s00296-007-0477-4. PMID 18038138.
  34. ↑ Pandita KK, Afaq S, Singh D, Mushtaq D, Masood I (February 2012). "Finger clubbing in a patient of myelofibrosis with renal cell carcinoma". J Assoc Physicians India. 60: 124–6. PMID 22715563.
  35. ↑ Hoffman, Ronald (2018). Hematology : basic principles and practice. Philadelphia, PA: Elsevier. ISBN 9780323357623.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Myelofibrosis_physical_examination&oldid=1508482"