In patients with primary myelofibrosis, anaemia is a common and impactful complication. A subset of these patients presents with an inadequate serum erythropoietin (EPO) response relative to the degree of anaemia, specifically an EPO level below 500 mU/mL. This pattern carries distinct management implications.
Myelofibrosis with anaemia and an inadequate serum erythropoietin level (<500 mU/mL). Routine practice indicates that patients with serum EPO below this threshold likely merit evaluation for an erythropoiesis-stimulating agent trial.
Before advancing to further therapies, initial management focuses on identifying and correcting reversible underlying causes contributing to the anaemia — including nutritional deficiencies and, where present, autoimmune mechanisms.
Serum EPO level — Inadequate*
However routine practice would suggest that those with EPO levels <500 mU/mL likely merit an ESA trial for 12 weeks.
Initial management is to correct any reversible haematinic deficiencies and to address any evidence of autoimmune haemolysis, albeit this is uncommon.
Initial management of anaemia should address any deficiencies of iron, folate or vitamin B12 and/or autoimmune haemolysis (Grade 1B).
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