(a) Clustering of numerous pleomorphic megakaryocytes; (b) low grade bone marrow reticulin fibrosis; (c) allele-specific PCR for MPL S505N demonstrating wild type band (363 bp) and S505N specific band (264 bp); lanes 1 & 6, 100 bp ladder; lane 2, peripheral blood; lane 3, buccal scrape; lane 4, isolated T-cells; lane 5, water control; (d) significant increase in bone marrow reticulin fibrosis two years after presentation.