Abdul Mannan/LinkedIn
May 6, 2026, 14:02
Abdul Mannan: Anemia in Myelofybrosis – Five Fires Behind One Falling Hb
Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, shared a post on LinkedIn:
“Your myelofibrosis patient’s Hb keeps dropping.
EPO isn’t working. Iron studies look strange.
You’re not sure what to try next.
Here’s why that happens.
Anaemia in MF rarely comes from one place. It usually comes from five.
The five mechanisms:
- Ineffective erythropoiesis: JAK2/CALR/MPL mutations dysregulate JAK-STAT signalling. Red cell progenitors (BFU-E, CFU-E) simply can’t mature normally.
- Hepcidin lock: IL-6 drives ACVR1/BMP-SMAD signalling, HAMP rises, ferroportin gets degraded, and iron stays trapped inside cells. Ferritin goes up. TSAT goes down.
- Fibrotic marrow: Reticulin and collagen replace haematopoietic space. Dry tap. MF grade 2/3. Almost no reserve left.
- Splenic sequestration: Extramedullary haematopoiesis turns the spleen into a red cell trap. A massive spleen makes every cytopenia worse.
- JAK-inhibitor cytopenia: JAK2 blockade suppresses EPOR signalling. Hb drop typically appears 8-12 weeks in. This was documented in both COMFORT-I and COMFORT-II trials.
The trap that catches everyone:
- High ferritin and low TSAT in MF is not iron deficiency. It is functional iron restriction. Giving iron here misses the point entirely and helps no one.
Understand the fire before you reach for the extinguisher.
What’s your approach when a patient on ruxolitinib has a worsening Hb?”
Other posts from Abdul Mannan on Hemostasis Today.
-
Sep 28, 2026, 14:45Access Real-Time Bleeding Disorder Guidelines with the New WFH Resource Hub – WFH
-
Sep 28, 2026, 14:44Subham Banerjee: When Routine Blood Grouping Hid a Rare Diagnosis
-
Sep 28, 2026, 14:41Francois Roubille: Can Low-Dose Colchicine Prevent Atrial Fibrillation After CABG?
-
Sep 28, 2026, 14:39William Aird: Gulliver’s Atlas – Mapping the Evolution of the Vertebrate Red Cell
-
Sep 28, 2026, 14:30Rafael Zubiran: High Lp(a) Drives 1 in 15 Cases of Aortic Stenosis
-
Sep 28, 2026, 14:23Heghine Khachatryan: Measuring the Human Impact of Gene Therapy on the Hemophilia
-
Sep 28, 2026, 13:48Can the Immune System Be Reprogrammed to Treat Aplastic Anemia?
-
Sep 28, 2026, 13:20Elif Susan Elcin։ PRP for Skin Rejuvenation – Is It Worth the Hype?
-
Sep 28, 2026, 13:07Alexandru Stieber: Looking Beyond MDS in VEXAS Syndrome