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Bone marrow histology is a powerful tool to differentiate between the myeloproliferative neoplasms (MPN) of essential thrombocythemia (ET) and polycythemia vera (PV) from all variants of primary or secondary erythrocytosis and reactive thrombocytosis with a sensitivity and specificity of 100%. Bone marrow histopathology on its own is not reliable to differentiate between WHO defined ET and PV. The majority of JAK2 mutated ET and all PV patients have increased scores for the leukocyte alkaline phosphatase (LAP) stain.