Use of platelet transfusions and tranexamic acid in patients with myelodysplastic syndromes: A clinical practice survey

Aim Thrombocytopenia and bleeding are common in myelodysplastic syndromes (MDS), but optimal management is unknown. We conducted a survey to identify current clinical practice regarding platelet transfusion (PLT‐T) and tranexamic acid (TXA) to inform future trial design. Method A 25‐question survey was distributed to members of the ALLG from December 2020 to July 2021. Results Sixty‐four clinicians across Australia, New Zealand and Singapore responded. Clinicians treated a median of 15 MDS patients annually. Twenty‐nine (45%) reported having institutional guidelines regarding prophylactic PLT‐T. Although 60 (94%) said they would consider using TXA, most (58/64; 91%) did not have institutional guidelines. Clinical scenarios showed prophylactic PLT‐T was more likely administered for patients on disease‐modifying therapy (49/64; 76%, commonest threshold <10 × 109/L) or with minor bleeding (32/64 [50%] transfusing at threshold <20 × 109/L, 23/64 [35%] at <10 × 109/L). For stable untreated patients, 29/64 (45%) would not give PLT‐T and 32/64 (50%) would. Most respondents (46/64; 72%) were interested in participating in trials in this area. Potential barriers included resource limitations, funding and patient/clinician acceptance. Conclusion Real‐world management of MDS‐related thrombocytopenia varies and there is a need for clinical trials to inform practice.