Acute Panmyelosis with Myelofibrosis: An Unusual Cause of Pancytopenia

A 56-year-old woman presented to her family physician with a 2-month history of dizziness, palpitations, dyspnea on exertion,and episodic chest discomfort. Initial investigations revealed amild pancytopenia. Two days later, she presented to emergencywith a low-grade fever (37.8oC), left-sided chest discomfort, andweakness. She denied any infectious or bleeding symptoms andhad no significant past medical history, including no medications. On examination, the patient had no lymphadenopathy, andher cardiac, respiratory, and abdominal examinations were unre-markable, with no hepatosplenomegaly. Her investigationsrevealed a pancytopenia (see Table 1). On the basis of her neu -tropenia and low-grade fever, she was admitted for intravenousantibiotics and work-up of her pancytopenia.In hospital, her pancytopenia persisted; her counts reached anadir of hemoglobin (Hgb) 46 g/L, platelets (Plt) 16 X 10