SHM Converge Scientific Abstract ePoster Gallery-Covid19 Induced Autoimmune Myelofibrosis; An Ever-Growing List of Covid19 Hematologic Sequelae

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This case report describes a 23-year-old man who developed severe anemia and was ultimately diagnosed with autoimmune myelofibrosis (AIMF), a rare form of bone marrow fibrosis usually linked to non-malignant autoimmune conditions. He had recovered from COVID-19 pneumonia about a year earlier and had received his second Pfizer COVID vaccine one week before presentation, raising concern for a post-COVID or vaccine-related immune trigger.<br /><br />He presented with worsening exertional shortness of breath, fatigue, weakness, and pallor. Initial evaluation showed profound normocytic anemia (hemoglobin 4.1) with normal white blood cell and platelet counts, elevated ESR and CRP, normal LDH, mildly elevated bilirubin, and high haptoglobin. Imaging was negative. Further testing showed a negative direct Coombs test, low reticulocyte count, and a largely unrevealing iron panel. Infectious studies, including hepatitis C, parvovirus, and EBV, were negative. Peripheral smear showed marked anemia with hypoproliferation.<br /><br />Bone marrow biopsy confirmed autoimmune myelofibrosis. Common causes of primary myelofibrosis were excluded: JAK2 V617F, MPL, and CALR mutations were negative, and systemic lupus erythematosus testing was also negative. He improved with a steroid taper, with a rebound in hemoglobin.<br /><br />The report emphasizes the difference between primary myelofibrosis, which is typically associated with malignancy or myeloproliferative disorders, and autoimmune myelofibrosis, which can occur after environmental triggers such as infection in genetically predisposed individuals. The authors suggest COVID-19 infection or vaccination may have triggered AIMF in this patient. They also stress the importance of avoiding diagnostic anchoring on COVID-related explanations and maintaining a broad differential diagnosis when evaluating hematologic abnormalities.

Asset Subtitle

David B. Jackson

Meta Tag

Author List Abu Baker Sheikh, David B. Jackson, Eyerusalem B. Akpan

Category Clinical Vignettes

Concept Primary Myelofibrosis

Concept Autoimmune Myelofibrosis

Concept Bone Marrow Biopsy

Concept Differential Diagnosis

Concept Comprehensive Workup

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author David B. Jackson

Track Adult

Keywords

autoimmune myelofibrosis

severe anemia

COVID-19

Pfizer vaccine

bone marrow fibrosis

steroid taper

normocytic anemia

JAK2 negative

bone marrow biopsy

immune trigger

Primary Myelofibrosis

Autoimmune Myelofibrosis

Bone Marrow Biopsy

Differential Diagnosis

Comprehensive Workup