If the cause of thrombocytopenia is ANKRD26-RT, an important principle in the management is avoiding harm by preventing patients from receiving treatments such as immunosuppressive treatment and splenectomy.[13] We added thrombopoietin receptor agonist (TPO-RA) avatrombopag to combine with steroid, and this case responded well to TPO-RA with a normalization of platelet count. Here, MPL is linked to Thrombocytopenia.