Diagnosis and Prognosis of Myelodysplastic Syndrome (MDS)

by Michael Jubinville, MPH

In some people, a problem is found during a routine blood test. Others may see their doctor when symptoms appear. The most common are feeling tired, bleeding problems, trouble breathing, or repeated infections. The doctor may think there is a blood disorder based on a physical exam, symptoms, and health past. Tests will help find a cause.

Testing for MDS

If your doctor thinks you have a blood disorder, blood tests will help find a cause. These may include:

Complete blood count—Measures the number of red blood cells, white blood cells, and platelets. Low numbers of healthy blood cells or high numbers of immature cells (called blasts) in the bone marrow may be found.
Blood smear—A drop of blood is looked at in a lab. It can show the number of each type of blood cell and the number of blasts and mature cells. The smear may find certain markers caused by problems with the genes.
Tests to check the levels of folate, vitamin B12, iron, or thyroid-stimulating hormone to rule out other diseases.
Tests to look for proteins or other markers. This can help if is hard to pinpoint a diagnosis.

Diagnosis of MDS

The findings from the blood tests can suggest MDS, but a bone marrow test is the only way to confirm it.

A bone marrow aspiration removes a sample of bone marrow from the bone. In most cases, the sample is taken from the hipbone. A needle is inserted through the bone. The marrow is removed with a syringe. A piece of bone may also be removed for biopsy.

Both marrow and bone sample are looked at in a lab.

Classification of MDS

If MDS is found, the results of the biopsy and new tests will help find the type. This will help to look for details of the cancer. Classification, age, and overall health help find the outlook and a plan to treat MDS.

Tests

Blood and tissue tests done in a lab help to find the type of MDS, along with other details about the disease. They will look for cell proteins and other markers such as those found in the genes. The tests will compare normal cells with cancer cells. This helps find differences between MDS and other blood cancers.

Classification

Most cancers are classified by stage. This involves where the tumor is, how big it is, or if it has spread away from the original site. MDS starts in the bone marrow, which spreads cells all over the body. Staging is not used for MDS, but it can be classified by how the bone marrow looks, how the blood cells look, and whether or not the cells have certain details present or missing.

MDS classifications:

International Prognostic Scoring System

The International Prognostic Scoring System (IPSS) is used with another system called the French-American-British classification. It is rated on these 3:

The portion of blasts in the bone marrow
Problems with the genes
Blood cell counts

A score is given for each of the 3. The lower the score the better the outlook. The scores are added to get an IPSS score. There are 4 categories of these scores:

Low risk
Intermediate-1 risk
Intermediate-2 risk
High risk

WHO Prognostic Scoring System

The WHO Prognostic Scoring System (WPSS) uses these 3:

Type of MDS based on 8 WHO classifications
Problems with the genes
If a blood transfusion is needed or not

The score determines 1 of these 5 groups:

Very low risk
Low risk
Intermediate risk
High risk
Very high risk

References:

General information about myelodysplastic syndromes. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq#_1.

Myelodysplastic syndrome (MDS). EBSCO DynaMed Plus website. Available at:
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Myelodysplastic syndrome (MDS). Merck Manual Professional Version website Available at: https://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/myelodysplastic-syndrome-mds.

Tests for myelodysplastic syndromes. American Cancer Society website. Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/detection-diagnosis-staging/how-diagnosed.html.

Last reviewed December 2020 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 3/15/2021

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