Introduction
Evans Syndrome (ES) is a rare childhood autoimmune disorder characterized by anemia and thrombocytopenia and frequently accompanied by neutropenia1. Autoantibodies target red blood cells, platelets (PLT), and neutrophils leading to autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP) and autoimmune neutropenia, respectively. Responses to variety of immunosuppressive therapy (IST) approaches are often temporary; many cases experience a prolonged course, become refractory to a series of different IST interventions. Treatment of ES is largely through trial and error-like approach with differences in management between different centers 2. Here, we present the course of three children with refractory ES treated on bortezomib.