How would you approach transfusion-dependent anemia in an intermediate-risk MDS patient refractory to azacitidine?

An MDS patient with ESRD likely has multiple contributors to their anemia. It is surprising to see the EPO level >500, but this may reflect the use of ESAs. If so, I would make sure that the dose is appropriate for MDS (60,000 units at least weekly) and that it is not renally dosed. If the patient i...