Myelofibrosis

Repeat bone marrow examination and cytogenetic or imaging studies are only appropriate if there is a change in symptoms, signs, or blood counts. There is no set time for outpatient follow-up. The frequency and interval of follow-up visits depend on the degree of cytopenia and blood products transfusion.

Full blood count with differential and lactate dehydrogenase (LDH)

• Patients should be closely monitored for transformation to acute leukaemia. This may be heralded by a fall in the platelet count <100 × 10⁹/L (100 × 10³/microlitre), or peripheral blood blasts increasing to >10%, or cytogenetic evolution, or increasing LDH.

Antibiotic prophylaxis

• Antibiotic, antiviral, and antifungal prophylaxis may be indicated for some patients with neutropenia. Patients taking chronic corticosteroids may need prophylaxis against Pneumocystis jirovecii.

Monitoring of adverse effects of treatment modalities

• Patients receiving cytoreductive therapy must be monitored closely for adverse effects.