Monitoring and Managing Anemia in Patients on Ruxolitinib


Dr. Bose shares his perspective on how he monitors and manages anemia for patients on ruxolitinib, including when he would consider dose reduction or transfusion.

Case: Intermediate-Risk Primary Myelofibrosis in a 68-Year-Old Woman

Clinical Presentation:

  • A 68-year-old woman presented to her physician with symptoms of mild fatigue.
  • Spleen was palpable 6-7 cm below the left costal margin.

PM: No known comorbidities

Initial Clinical Workup and Diagnosis:

  • NGS Testing: JAK2 V617F mutation
  • Karyotype: 46XX
  • BM biopsy: megakaryocyte proliferation and atypia with evidence of reticulin fibrosis
  • Blood smear: leukoerythroblastosis
  • Diagnosis: Primary myelofibrosis
  • Risk:
    • DIPSS: Intermediate-2
    • Mipss70: Intermediate risk
  • Lab Values
    • RBC 3.40 x 1012/L
    • Hgb 9.7 g/dL
    • HCT 32.3%
    • MCV 94 fL
    • WBC 23.0 x 109/L
    • PLT 450 x 109/L
    • PB Blasts <1%

Initial Treatments:

  • Initiated on ruxolitinib.
    • The patient was not interested in transplant.
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