Symptoms of myelofibrosis with myeloid metaplasia depend on the type of blood cell affected. Problems with red blood cells may put patients at risk for symptoms of anemia such as shortness of breath and fatigue. Decreases in the white blood cell count can depress the immune system and increase risks of infection. Decreases in platelets can lead to bleeding. Patients may develop enlarged spleens (splenomegaly) from the leukemialike cells produced by marrow that accumulate in the body. Patients can also experience fatigue, night sweats, weight loss and bone pain.