In a patient with progressive thrombocytosis but negative MPN mutations on peripheral blood, what are your diagnostic and treatment recommendations?

I agree with Dr. @Dr. First Last. A bone marrow biopsy is helpful in a case like the one described as morphology can be informative in distinguishing triple negative ET vs pre-MF vs MF and also CML. I agree with NGS panel to see if there are clonal markers identified, testing for BCR-ABL is critical...

It may be worth doing a broader look for clonality. A bone marrow biopsy can evaluate for morphologic and immunohistochemical evidence (megakaryocytic morphology and pSTAT5 staining, or even ringed sideroblasts in instances of MDS/MPN-RS-T) and cytogenetics can identify clonality. A wider NGS panel ...