Abdul Mannan: The Clinical Pattern That Should Make You Think of VEXAS
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“VEXAS Series – 3 LinkedIn Posts
POST 1 of 3 – VEXAS: The Big Picture
An older man. Fever. Ear chondritis. Macrocytic anaemia. Cytopenia.
Rheumatology refers him to haematology.
Haematology refers him back.
Everyone is partly right. No one has the full answer.
Until you look at his bone marrow.
That’s VEXAS. And it’s sitting in your clinic right now.
VEXAS stands for:
- Vacuoles
- E1 enzyme
- X-linked
- Autoinflammatory
- Somatic
It’s caused by a somatic mutation in the UBA1 gene – the gene that runs the ubiquitin system, the cell’s own protein clean-up mechanism.
When UBA1 fails, cells accumulate stress.
Inflammation ignites.
And the bone marrow starts showing visible damage.
Here’s what to look for clinically:
- Fever and recurrent systemic inflammation
- Chondritis — ears and nose
- Skin lesions
- Eye involvement
- Lung disease
- Macrocytic anaemia with low WBC and/or platelets
And on the bone marrow:
- Vacuoles in early neutrophil precursors
- Vacuoles in early erythroid precursors
One thing every haematologist must know: vacuoles are suggestive, not diagnostic.
MDS, copper deficiency, alcohol excess, malnutrition, and active inflammation can all produce the same picture.
The clinical signal is this: older adult plus inflammation plus cytopenia plus macrocytosis plus vacuolated marrow precursors.
Confirm with UBA1 testing.
This is Part 1 of my 3-part VEXAS series.
Tomorrow: how to use marrow morphology as a practical triage tool.
Have you diagnosed VEXAS in your centre? I’d love to hear your experience.”
Other posts from Abdul Mannan on Hemostasis Today.
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Apr 30, 2026, 14:28Jennifer Le Mac: How the Immune System Shapes Venous Thrombosis
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Apr 30, 2026, 14:22Samantha Xavier: Successfully Defended My PhD Thesis on P-Selectin as a Biomarker for Venous Thromboembolism
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Apr 30, 2026, 14:09Robert Lufkin: Anti-Amyloid Drugs Fail Alzheimer’s Patients
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Apr 30, 2026, 13:54Matthew D. Neal: A Major Step Forward in Trauma and Resuscitation Science
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Apr 30, 2026, 13:35Day 2 of the EHC Youth Leadership Workshop 2026
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Apr 30, 2026, 13:23The Gap Between Clinical Assessment and Patient Experience in VTE – RPTH Journal
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Apr 30, 2026, 13:17Low Absolute Neutrophil Count Doesn’t Always Indicate Pathology – ASH Education
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Apr 30, 2026, 13:01William Aird: When Inducers Make DOACs Fail
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Apr 30, 2026, 12:56Abdul Muqtadir Abbasi: HIT Management – Avoid Platelet Transfusion