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.
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Jun 24, 2026, 07:46Wolfgang Miesbach: WFH’s First AAV Gene Therapy Chapter Marks a New Era in Hemophilia Care
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Jun 24, 2026, 06:42Deepthi Krishna: World Blood Donor Day 2026 Celebrations at Rela Hospital
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Jun 24, 2026, 03:36Ana Pedrero Gil: A New Approach to Post-Tonsillectomy Hemorrhage
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Jun 24, 2026, 02:59Melissa Hollo: Making Early Anemia Detection the Standard of Care
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Jun 24, 2026, 02:51Bruno Pougault: The Thin Line Between Bleeding and Clotting