Abstract :Cryptogenic Chronic Liver Disease (CLD) remain an important cause of chronic liver disease
where no etiological inciting agent could be attributed to causation of disease, with recent advances
in diagnostic testing the prevalence of cryptogenic CLD have decreased though not completely
eliminated. We report a case of a 45-year-old female who underwent combined liver and kidney
transplant for cryptogenic chronic liver and kidney disease. Her explant liver pathology revealed
extensive extramedullary hematopoiesis with many atypical megakaryocytes and advance fibrosis.
She subsequently underwent bone marrow aspiration and biopsy and was finally diagnosed as a case
of primary myelofibrosis. Post transplant her platelet count peaked to 12 lakhs and she was started
on hydroxyurea. Her platelets became normal following 2 weeks of therapy and dropped to about
4 lakhs.