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When these cells are activated in the MPNs, their interactions with each other create a highly proadhesive and prothrombotic milieu in the circulation that predisposes patients with MPN to venous, arterial, and microvascular thrombosis and occlusive disease. Bleeding problems in the MPNs are caused by the MPN blood cell-initiated development of acquired von Willebrand disease. The inflammatory state created by MPN stem cells in their microenvironment extends systemically to amplify the clinical thrombotic tendency and, at the same time, preferentially promote further MPN stem cell clonal expansion, thereby generating a vicious cycle that favors a prothrombotic state in these diseases.<\/jats:p>","DOI":"10.1182\/blood.2020008109","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T22:53:50Z","timestamp":1614639230000},"page":"2152-2160","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":103,"title":["The pathobiology of thrombosis, microvascular disease, and hemorrhage in the myeloproliferative neoplasms"],"prefix":"10.1182","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3936-8032","authenticated-orcid":false,"given":"Hans Carl","family":"Hasselbalch","sequence":"first","affiliation":[{"name":"Department of Hematology, Zealand University Hospital, Roskilde, Denmark;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margitta","family":"Elvers","sequence":"additional","affiliation":[{"name":"Clinic of Vascular and Endovascular Surgery, D\u00fcsseldorf, Germany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew I.","family":"Schafer","sequence":"additional","affiliation":[{"name":"Richard T. 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