Anemia isn’t always caused by iron deficiency. It can also indicate serious bone marrow disorders such as myelofibrosis. In this article, Dr Daryl Tan, a consultant haematologist in Singapore, shares insights on the link between anemia and myelofibrosis, symptoms to watch for, available treatments, and the importance of early diagnosis.
Anemia is often misunderstood as simply a result of iron deficiency, but it can also signal more serious conditions like myelofibrosis, a rare bone marrow disorder where fibrous tissue replaces healthy marrow, leading to low blood cell counts, systemic symptoms, and an enlarged spleen. Globally, about 40% of myelofibrosis patients present with moderate to severe anemia at diagnosis, and nearly all develop it over time.
As Featured in Lianhe Zaobao
This is an English translation of Dr Daryl Tan’s interview, first published in Lianhe Zaobao on 1 July 2025. Read on to find out how anemia can be a sign of myelofibrosis, what symptoms to watch for, treatment options, and when to get medical help.
The Link Between Myelofibrosis and Anemia
A 72-year-old patient, Mr. Wai (pseudonym), was diagnosed with polycythemia vera (a blood disorder causing excessive red blood cell production) a decade ago. While his condition was managed with aspirin and hydroxyurea, his hemoglobin levels dropped significantly by 2023, leading to complications like thrombocytosis and slowed blood circulation.
For such cases, JAK2 inhibitors can help reduce spleen size and partially restore bone marrow function. However, patients may still require frequent blood transfusions.
How Common Is Myelofibrosis-Related Anemia?
While anemia is widespread (often due to iron deficiency), myelofibrosis itself is rare, with only about 10 cases per million annually. Most patients are diagnosed around age 65. Chronic myelofibrosis patients must monitor their bone marrow health, as long-term damage can severely impair blood cell production.
Symptoms and Risks
Beyond anemia, myelofibrosis symptoms include:
- Weight loss
- Abdominal discomfort (from spleen enlargement)
- Fever, bone pain, and fatigue
Severe anemia can escalate into heart failure, heart attacks, or strokes—prompting the need for early medical intervention.
Treatment Options and Challenges
JAK2 inhibitors, recently approved for local use, can alleviate symptoms by shrinking the spleen and improving blood production. Younger patients may consider stem cell transplants, though treatments require close monitoring for side effects like infections or bleeding. Prognosis varies, with survival ranging from months to years depending on disease progression.
Meet Our Haematologist
Dr Daryl Tan Chen Lung
MBBS (Singapore), MRCP (UK), MMED (Int Med), FAMS (Haematology)
Dr Daryl Tan is a haematologist in Singapore with clinical interests in lymphoma, multiple myeloma, leukaemia, and other blood disorders. His care includes diagnosis, treatment planning, chemotherapy, targeted therapy, and immunotherapy.