Abstract
Primary myelofibrosis is a myeloproliferative neoplasm associated with a progressive fibrosis of the bone marrow, which results in insufficient hematopoiesis and is characterized by a low survival rate. It may be frequently associated with a thrombembolic event, and the latter may precede the diagnosis of myelofibrosis. The concomitant treatment of these two nosological entities is a challenge as it limits the use of drugs that can control long-term complications. We present the case of a 62-year-old patient with a history of pulmonary thrombembolism, who addressed the Emergency Department with the following accusations: inflammatory edema of the lower right limb, palpitations, dizziness, diaphoresis, dyspnea at regular efforts. Based on the clinical signs and objective examination, vascular ultrasonography, the diagnosis of deep vein thrombosis was established. Complete blood count and marked splenomegaly raised suspicion about the presence of a myeloproliferative disease. The bone marrow biopsy and identification of the JAK2V617F supported the diagnosis of primary myelofibrosis. Anticoagulant treatment was performed, but there were two recurrences of deep vein thrombosis prior to the inclusion in the ruxolitinib treatment program. The aim of this paper is to emphasize the role of the predictive factor of thromboembolic events in myelofibrosis and the role of personalized therapy in the management of these patients. The report concluded that a complex therapy, personalized to each individual case, lead to improved prognosis of these patients.