Haematology: essential thrombocythaemia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: essential thrombocythaemia

Sample item

A 55-year-old woman has burning pain and redness of the fingers that is relieved by cooling. Platelet count is 900 x 10^9/L, haemoglobin is normal, and BCR-ABL testing is negative. A JAK2 V617F mutation is found. What is the most appropriate drug for her symptoms?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Low-dose aspirin

Essential thrombocythaemia is a myeloproliferative neoplasm with JAK2, CALR or MPL mutations, and microvascular occlusion produces erythromelalgia. Low-dose aspirin relieves the symptoms and reduces thrombotic risk, and cytoreduction with hydroxyurea is added in high-risk patients. Extreme thrombocytosis above about 1,000 can also cause acquired von Willebrand syndrome, so aspirin needs caution when that is suspected.

Option by option

  • A. Low-dose aspirin (correct)

    Low-dose aspirin inhibits platelet thromboxane and relieves erythromelalgia.

  • B. Imatinib

    Imatinib treats BCR-ABL positive CML, and the test here is negative.

  • C. Routine plateletpheresis

    Plateletpheresis is reserved for acute life-threatening thrombosis or haemorrhage and is not routine.

  • D. Warfarin

    Warfarin is not the standard agent for primary prevention in this disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Low-dose aspirin. Essential thrombocythaemia is a myeloproliferative neoplasm with JAK2, CALR or MPL mutations, and microvascular occlusion produces erythromelalgia.

Why is "Imatinib" not the answer?

Imatinib treats BCR-ABL positive CML, and the test here is negative.

Why is "Routine plateletpheresis" not the answer?

Plateletpheresis is reserved for acute life-threatening thrombosis or haemorrhage and is not routine.

Why is "Warfarin" not the answer?

Warfarin is not the standard agent for primary prevention in this disease.

What concept does this question test?

It tests Haematology: essential thrombocythaemia in Pathology. Low-dose aspirin relieves the symptoms and reduces thrombotic risk, and cytoreduction with hydroxyurea is added in high-risk patients. Extreme thrombocytosis above about 1,000 can also cause acquired von Willebrand syndrome, so aspirin needs caution when that is suspected.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: essential thrombocythaemia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.