Plummer-Vinson syndrome and reactive thrombocytosis mask a JAK2-V617F positive myeloproliferative neoplasm.

A 52-year-old woman presented with abdominal pain, dysphagia, and fatigue. She had gastric adenocarcinoma treated with lower esophago-gastroduodenectomy without splenectomy and chemoradiotherapy 6 years prior. CT angiography demonstrated a thrombus in the abdominal aorta with bilateral embolic kidney infarcts, but no tumor recurrence nor organomegaly. Laboratory findings included: hemoglobin 7 g/dL, MCV 61 fL, platelet count 750 thou/ L, normal WBC, reticulocytes 2.5%, serum ferritin 6 ng/mL, serum iron 12 ug/dL, and transferrin 400 g/dL. Peripheral smear showed thrombocytosis (normal morphology), hypochromia, and anisopoikolocytosis (main panel). Oral iron absorption test showed no absorption, presumed secondary to extensive surgery. Upper endoscopy demonstrated upper esophageal webs (inset).