Myelofibrosis Associated, with Rickets, is it Hyperparathyroidism the Triggering Agent or Vitamin D and Hypocalcemia or Hypophosphatemia?

Vitamin D deficiency rickets presenting with hypocalcemia and clinical rickets is not uncommon in sunny countries as it is supposed to be [1]. Factors associated with the increased prevalence of nutritional rickets in sunny countries, included housing, environmental factors and customs associated with avoidance of sun by every member of the families, especially mothers who were found to be vitamin D deficient and their infants born with vitamin D deficiency [2-4]. Iron deficiency anemia was reported among infants with rickets by Grundulis in association with rickets among Asian immigrants in the UK [5]. We have recently reported this association of vitamin D deficiency rickets with iron deficiency anemia in an all year sunny country, Saudi Arabia. It was found that out of 97 infants with rickets 45 (46.4%) were having a hemoglobin less than 11 grams [6], which is considered anemic according to WHO [7]. On reviewing the reported cases of myelofibrosis, with rickets are even very rare. No case was reported in this region since the first one in 1994 [8], although rickets and associated iron deficiency anemia are very common. On reviewing myelofibrosis associated with rickets in a trial to pick which of the biochemical abnormalities associated with rickets were the triggering agent for myelofibrosis, namely hypovitaminosis D, hypocalcemia, hypophosphatemia or hyperparathyroidism or a combination of any. Another objective of this review is to stress on the seriousness of rachitic myelofibrosis as a life threatening condition among the highest incidence of iron deficiency anemia causes associated with rickets. Not, to miss this serious anemia and be able to diagnose it in communities with high prevalence of rickets and anemia.