Diagnosis and subtype
MPN is suspected when blood counts are persistently abnormal, especially with an enlarged spleen or a history of thrombosis. JAK2, CALR and MPL mutation testing, together with bone marrow morphology, separates polycythaemia vera, essential thrombocythaemia and myelofibrosis.
Secondary causes of high counts — dehydration, hypoxia, infection, iron deficiency, inflammation and medication — must be excluded before a clonal MPN is diagnosed.
Related: Haematology → · Dr. Sachita Baniya profile → · All conditions →
Risk assessment
The main risks are thrombosis, bleeding and progression to myelofibrosis or acute leukemia. Risk depends on age, prior thrombosis, blood counts, mutation profile and marrow findings.
Cardiovascular risk factors, smoking, blood pressure, diabetes and lipid status are reviewed alongside the MPN, because they influence the overall thrombotic risk.
- History of arterial or venous thrombosis
- Age and cardiovascular risk factors
- Platelet and haematocrit trends
- Spleen size, symptoms and blast count
Treatment and monitoring
Therapy may include low-dose aspirin, phlebotomy for polycythaemia, cytoreductive drugs such as hydroxyurea, and JAK inhibitors for symptomatic myelofibrosis or high-risk disease. Treatment is tailored to the subtype and risk.
Monitoring includes blood counts, spleen size, symptoms, thrombosis and signs of progression. Allogeneic transplant is considered in selected high-risk or advanced myelofibrosis.
Access and booking
Dr. Baniya consults at Kathmandu Neurology Clinic & Cognitive Center, Durbar Marg, and also practises at Kathmandu Cancer Center (KCC) Nepal, Civil Service Hospital, Kathmandu, and Advanced Care Hospital. Appointments are arranged at the Durbar Marg clinic or through the respective hospital or cancer centre. Bring all blood counts, marrow, flow cytometry and molecular reports.