Myelodysplastic syndromes (MDS) are a group of blood cancers that affect the bone marrow and can result in a low levels of blood cells. When MDS affects red blood cells, it can lead to anemia in some people.

A low red blood cell count (hemoglobin) is a key feature of anemia. With MDS, anemia occurs because the bone marrow does not work correctly. This can be due to several reasons, including the accumulation of irregular cells in the bone marrow and the bone marrow not producing blood cells properly.

MDS-associated anemia can lead to symptoms such as fatigue, weakness, and pale skin. Treatment usually involves addressing the underlying cause of MDS. Many supportive measures are available to help improve a person’s quality of life.

Read on to learn more about anemia with MDS, including symptoms, causes, and treatment. This article also discusses the outlook for MDS.

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Anemia is relatively common in people with MDS:

What causes MDS?

While the exact cause of MDS is unclear, experts speculate that changes in the DNA of the bone marrow’s stem cells contribute to the disease. Other factors that could play a role in the development of MDS include aging because aging stem cells are more likely to develop abnormalities.

MDS can cause low levels of different types of blood cells in the bone marrow.

Also, the following may increase a person’s risk of developing MDS:

Anemia associated with MDS

In MDS, anemia develops because the bone marrow is not working properly.

Irregular or immature cells may accumulate in the bone marrow, crowding “normal” red blood cells. Or, the MDS may mean that the bone marrow cannot make red blood cells properly.

Anemia in MDS can lead to the following symptoms:

These are typical symptoms of anemia, even if MDS is not the underlying cause.

However, a person’s symptoms can depend on other factors, including the underlying cause of anemia. If MDS is the underlying cause, symptoms may differ according to how far advanced the MDS is.

Learn more about the symptoms of MDS here.

To diagnose MDS-associated anemia, doctors will do the following:

  • check a person’s medical and family history
  • a physical exam
  • order tests


The tests will usually involve a complete blood count to check the blood levels of:

Lab technicians can also assess the size, shape, and number of blood cells using a blood smear.

Doctors might also decide to check for atypical levels of other substances, such as:

Doctors may also recommend bone marrow testing. These tests can identify any irregularities relating to the number, type, size, and shape of blood cells and any changes to the cell’s genes.

Treatment options for anemia and MDS are detailed below:

Treating anemia

Doctors treat anemia by finding and treating the underlying cause. This could involve avoiding exposure to a particular chemical or MDS medication.

Treatment aims to improve red blood cell counts. This can bring symptom relief and improve a person’s quality of life.

A person may receive one or more of the following therapies:

Treating underlying MDS

It usually involves supportive care, which aims to:

  • relieve symptoms
  • improve quality of life
  • prevent bleeding and infections

Supportive care is beneficial as most people with MDS are older adults who may have additional health problems.

Other possible treatments for MDS include occasional or more regular blood transfusions, which temporarily relieve anemia, fatigue, and bleeding. Blood transfusions work by increasing the number of red blood cells, platelets, or both in a person’s blood.

MDS medications include ones that:

  • stimulate bone marrow
  • treat or prevent infections
  • prevent the growth of irregular bone marrow stem cells and increase the number of healthy blood cells — for example, the hypomethylating agents azacitidine or decitabine
  • slow the growth of irregular blood cells and reduce the need for blood transfusions — for example, the immune modulator lenalidomide

Stem cell transplants

That said, stem cell transplants can provide a possible cure for some people. This involves replacing a person’s damaged stem cells with healthy stem cells from a closely matched donor. A person with MDS may receive chemotherapy alongside a stem cell transplant or by itself.

Those waiting for a stem cell transplant or those ineligible for one may benefit from immunosuppressive therapy. This works on the immune system, slowing or stopping bone marrow damage.

Learn more about treating MDS.

A 2021 study states that despite many people seeing initial benefits from erythropoiesis-stimulating agents, many develop resistance to these medications over time and need blood transfusions.

Blood transfusions can help treat the anemia, but there can be downsides, such as iron buildup in the body. A person may then need iron chelation therapy. They can also experience higher healthcare costs and lower quality of life.

Doctors commonly use the Revised International Prognostic Scoring System (IPSS-R) to determine the outlook for someone with MDS. It takes into account the following:

  • a person’s levels of red blood cells, white blood cells, and platelets
  • the percentage of blasts (immature cells) in their bone marrow
  • whether they have chromosome changes and which types

Doctors can then assign a person to a risk group to estimate how likely they are to develop acute myeloid leukemia — a rare cancer of the bone marrow and blood — and their overall chances of survival.

The table below outlines overall survival times for MDS, as reported by the American Cancer Society:

IPSS-R risk groupMedian survival time
very low8.8 years
low5.3 years
intermediate3 years
high1.6 years
very high0.8 years

MDS is a group of rare blood cancers that result in the bone marrow struggling to produce healthy blood cells, including red blood cells. In some people, MDS can lead to anemia.

Having anemia with MDS can lead to symptoms of fatigue, unusually pale skin, shortness of breath during activity, and dizziness, among others. Doctors may diagnose the condition based on results from blood tests, which show low levels of healthy red cells and other blood components.

Treatment focuses on treating symptoms and can include a combination of blood transfusions, stem cell transplants, immunosuppressive therapy, and medications.

A person’s outlook depends on many factors, including how they respond to treatment and how advanced the MDS is.