Immune-mediated platelet transfusion refractoriness in a severely thrombocytopenic patient with myelodysplastic syndrome successfully treated with romiplostim.

Immune-mediated platelet transfusion refractoriness due to anti-human leukocyte antigen (HLA) antibodies can occur in approximately 9% of patients with myelodysplastic syndromes (MDS) and can lead to an increased risk of clinically relevant bleeds and treatment delays. These patients are typically managed with frequent platelet transfusions; however, HLA-matched platelet transfusions are usually available only in large blood centers. For this reason, alloimunized thrombocytopenic MDS patients are notoriously difficult to manage.