Cytopenias of varying severity are characteristic of MMM and are multifactorial. Anemia is the most common cytopenia and can be caused by (1) ineffective hematopoiesis, (2) decreased marrow production capability because of the severity of the reactive fibrosis, (3) splenic sequestration, (4) myelosuppression from MMM therapy (i.e., from hydroxyurea), (5)

hemolysis, or (6) bleeding from the gastrointestinal tract (e.g., from varices resulting from portal hypertension). Thrombocytopenia also occurs in MMM, although it is less common than anemia at presentation, and may result from the same factors that cause anemia, as well as from consumption through disseminated intravascular coagulation.

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