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Diagnosis and Prognosis of Myelodysplastic Syndrome (MDS)
by Ricker Polsdorfer, MD and Patricia Griffin Kellicker, BSN
Diagnosis often starts when someone sees their doctor for symptoms, such as fatigue, bleeding problems, difficulty breathing, or persistent infections. For others, abnormal test results during routine physical exams may prompt an investigation into blood disorders like MDS.
Testing for MDS
If you are having symptoms and your doctor suspects a blood disorder, blood tests will help identify any abnormalities in the development or numbers of blood cells. Blood tests can include:
Diagnosis of MDS
The findings from the blood tests can suggest MDS, but a bone marrow test is usually done to confirm the diagnosis.
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 and the marrow is removed with a syringe. A piece of bone may also be removed for biopsy.
Both marrow and bone sample will be examined under a microscope to look for the presence of abnormal blood cells (cancer).
Classification of MDS TOP
If MDS is confirmed, the results of the biopsy and new tests will help determine the classification of cancer. This will help to identify characteristics of the cancer. Classification, as well as other information like age and overall health, will help develop the prognosis and treatment plan.
In-depth testing of blood and tissue samples can help identify the type of MDS and any other specific characteristics. Tests may include:
Classification of MDS
Most cancers are staged by the presence of tumors, their size, or if it has spread beyond the primary site. MDS affects the bone marrow, which affects the whole body. Traditional staging is not used for MDS, but the disease can be classified by the appearance of the bone marrow and the blood cells, and whether or not certain characteristics are present or missing.
International Prognostic Scoring System
The International Prognostic Scoring System (IPSS) is used in conjunction with another system, the French-American-British classification, which rates 3 factors:
A score is given for each of the 3 factors. The lower the score the better the prognosis. The scores are added together to get an overall IPSS score. There are 4 categories of IPSS scores:
WHO Prognostic Scoring System
The WHO Prognositic Scoring System (WPSS) uses 3 factors:
The score determines one of the following 5 groups:
General information about myelodysplastic syndromes. National Cancer Institute website. Available at: https://www.cancer.gov/types/myeloproliferative/patient/myelodysplastic-treatment-pdq. Updated August 12, 2015. Accessed June 30, 2017.
How are myelodysplastic syndromes diagnosed? American Cancer Society website. Available at: https://www.cancer.org/cancer/myelodysplastic-syndrome/detection-diagnosis-staging/how-diagnosed.html. Updated February 10, 2014. Accessed June 30, 2016.
Myelodysplastic syndrome. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated January 13, 2017. Accessed June 30, 2017.
Myelodysplastic syndrome. Merck Manual Professional Version website Available at:
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Updated January 2017. Accessed June 30, 2017.
Last reviewed June 2017 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 6/30/2016
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