A 65-year-old patient presented to the medicine OPD with weakness and fatigue for 6 months along with some mild abdominal discomfo.On examination, moderate splenomegaly was noted. Lab findings Severe normocytic normochromic anemia Neutropenia with monocytopenia Thrombocytopenia. Bone marrow aspiration was done to look for the cause of decreased cell counts but the tap came ‘dry’. So, a bone marrow biopsy was performed. BM Biopsy All of the following CD markers can be positive in above condition except : –

## **Core Concept**
The patient's presentation suggests a bone marrow disorder characterized by cytopenias (anemia, neutropenia, thrombocytopenia) and splenomegaly. The "dry tap" during bone marrow aspiration followed by a biopsy is indicative of marrow fibrosis or infiltration. The condition described is likely **Primary Myelofibrosis (PMF)** or another form of myeloproliferative neoplasm (MPN). Immunophenotyping with CD markers can help in diagnosing and differentiating various hematological malignancies.

## **Why the Correct Answer is Right**
In the context of myeloproliferative neoplasms or conditions leading to marrow fibrosis and cytopenias, certain CD markers can be expressed. For instance, **CD117 (c-KIT)**, **CD34**, and others can be relevant. However, **CD20** is more typically associated with B-cell lineage lymphoproliferative disorders. Given the clinical scenario suggestive of a myeloproliferative or bone marrow fibrotic process rather than a B-cell malignancy, CD20 would be less likely to be positive in this context.

## **Why Each Wrong Option is Incorrect**
- **Option A: CD117 (c-KIT)**: This is a receptor tyrosine kinase important in the development of various cell types, including hematopoietic cells. It can be positive in some myeloproliferative neoplasms.
- **Option B: CD34**: A marker for hematopoietic progenitor cells, which can be expressed in various conditions including myeloproliferative neoplasms.
- **Option D: CD68**: A marker for monocytes/macrophages, which can be seen in certain myeloproliferative neoplasms or in conditions with monocytic differentiation.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **Primary Myelofibrosis (PMF)** often presents with cytopenias, splenomegaly, and a "dry tap" on bone marrow aspiration due to fibrosis. The bone marrow biopsy is crucial for diagnosis and can show fibrosis, and the expression of certain CD markers can help differentiate PMF from other causes of bone marrow failure or myeloproliferative diseases.

## **Correct Answer:** . **CD20**

✓ Correct Answer: C. CD117