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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May 6, 2026, 14:00Mona Alfaraj: Advancing Care in Inherited Platelet Disorders at 2nd International Hematology and Hemostasis Conference
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May 6, 2026, 13:56Mahesan Subramaniam: Why Delayed Cord Clamping Benefits Newborn Health
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May 6, 2026, 13:44Wolfgang Miesbach: Octreotide as a First‑Line Systemic Option in VWD Patients With Angiodysplasia‑Related GI Bleeding
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May 6, 2026, 13:42Irogue Igbinosa: Rethinking Iron Deficiency in Pregnancy with Intravenous Therapy
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May 6, 2026, 13:34Manaf Aljishi: Three Posters Presented at the Hematology and Hemostasis Conference 2026
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May 6, 2026, 13:33David Ferreira: Insights from the 1st National Meeting of Young Immunohematologists in Abrantes
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May 6, 2026, 13:22Nicholas Lee: Honored to Join ASH CRTI Program for Aplastic Anemia Research
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May 6, 2026, 13:16Mehari Gebreyohanns: Transition from Alteplase to Tenecteplase Is Full Steam Ahead in Texas
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May 6, 2026, 12:53Masoabi Sefojane: In Africa 88% of Hemophilia Remains Undiagnosed