2) Laboratory investigations
The most basic lab investigation is a CBC which count the number of blood cells, mostly by using an automated analyzer. In myelofibrosis it may show anemia -which a decreased hemoglobin level and red cell count- and thrombocytopenia -which is a decreased platelet count- or thrombocytosis -elevated platelet count-. Although it seems more logical that platelets should be less, it is actually more common to have elevated platelet count since these cells are most commonly uncontrollably dividing. A falling platelet count indicates that the fibrosis of the bone marrow has become more extensive and the disease has progressed.
Those finding are not enough to diagnose myelofibrosis, but should direct the physician to a diagnosis of aplastic anemia, a type of anemia caused by a problem in the manufacturing plant, the bone marrow.
The second step after counting the number of cells is to check them under the microscope by a professional pathologist, this is called blood film. In myelofibrosis, white blood cells show certain abnormalities that suggest the condition.