Proplatelets represent pseudopodia of megakaryocytes which extend into bone marrow sinuses to release platelets. Proplatelets were visualized by immunohistochemical and confocal microscopy. In trephines from essential thrombocythaemia (ET, n=10), fibrotic (n=10) and pre-fibrotic (n=10) primary myelofibrosis (PMF) there was a significant increase of proplatelet density compared with normal bone marrow samples (n=10; p<0.001). Manifest fibrosis exhibited the highest density and volume ratio with significant differences to non-fibrotic PMF (p<0.001) and ET (p<0.001). This study demonstrates that besides megakaryocytic proliferation extensive pseudopodial proplatelet formation provides a hallmark of MPN. Fibrosing differ from non-fibrosing MPN by density and size of aberrant proplatelets.
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