Subtle shifts in energy, bruising, or susceptibility to infections are easy to dismiss, especially with other medical conditions or medications in the picture. Yet persistent patterns may point to problems in how the bone marrow makes red cells, white cells, and platelets. Understanding what these signals mean, and how clinicians investigate them, helps people know when to seek evaluation and how to navigate next steps.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.

How is MDS diagnosed with blood and bone marrow tests?

Evaluation typically starts with a complete blood count (CBC) and differential to measure red blood cells, white cells, and platelets. In suspected myelodysplastic syndromes (MDS), results may show anemia, low white cells (neutropenia), and/or low platelets (thrombocytopenia). A peripheral smear can reveal cell size and shape changes, and a reticulocyte count helps show whether new red cells are being made. Clinicians also check for reversible causes such as iron, vitamin B12, or folate deficiency; chronic kidney or thyroid disease; alcohol use; and medication effects before concluding that marrow dysfunction is likely.

If concerns persist, diagnosis often requires a bone marrow aspiration and biopsy. These procedures assess cellularity, dysplasia (abnormal cell development), and the percentage of immature cells known as blasts. Cytogenetic testing looks for chromosome changes, and molecular testing evaluates gene mutations that can refine diagnosis and prognosis. Together, these blood and marrow tests clarify whether changes are consistent with MDS and guide the risk level assigned for treatment planning.

What are the differences between MDS and leukemia?

MDS and acute myeloid leukemia (AML) both involve marrow cells, but their behavior differs. MDS features ineffective, dysplastic blood cell production that causes chronically low counts. AML is characterized by a rapid increase in blasts that crowd out normal production. A key practical distinction is blast percentage: higher levels—often around 20% or more in marrow—support AML, whereas lower levels with dysplasia support MDS. Some MDS cases may evolve into AML over time, but many remain stable or progress slowly, so monitoring and management strategies are tailored accordingly.

Treatment approaches based on MDS risk level

Risk assessment tools such as IPSS-R or IPSS-M incorporate blood counts, blast percentage, cytogenetics, and mutations to estimate outcomes and shape care. In lower-risk disease, goals prioritize symptom control and improved counts: watchful waiting with regular labs, red blood cell transfusions when needed, erythropoiesis-stimulating agents, iron chelation if transfusions are frequent, and sometimes granulocyte colony-stimulating factor to support white cells. Certain subtypes may benefit from targeted therapies based on specific biological features identified in testing.

Higher-risk disease often calls for disease-modifying treatment. Hypomethylating agents such as azacitidine or decitabine are commonly used to suppress abnormal cell growth and support healthier blood production. For medically eligible individuals, allogeneic stem cell transplant is the only potentially curative option, though it involves significant short- and long-term risks and requires careful evaluation by a transplant team. Clinical trials are relevant across risk levels and may provide access to emerging treatments under close oversight.

Living with chronic anemia and low blood counts

Anemia can make routine tasks tiring. Pacing activities, planning rest breaks, and prioritizing higher-energy times of day can help manage fatigue. When white cells are low, strategies include diligent hand hygiene, promptly reporting fevers, staying up to date with recommended vaccinations, and avoiding close contact with people who are ill. For low platelets, minimizing alcohol, using a soft toothbrush, and discussing blood-thinning medications or over-the-counter pain relievers with a clinician may reduce bleeding risk.

Nutrition and hydration support overall health; however, iron or vitamin supplements should not be started without lab guidance. People who receive repeated transfusions may develop iron overload and need monitoring of ferritin and potential chelation. Light, regular exercise—once cleared by a clinician—can improve endurance and mood. Keeping a record of symptoms, transfusions, and side effects, and bringing it to appointments, helps tailor care and anticipate needs.

Why regular blood work matters in older adults

As people age, mild blood count changes become more common and may stem from chronic conditions, medications, or nutritional issues. Regular blood work helps distinguish temporary fluctuations from persistent abnormalities that merit evaluation. If fatigue, infections, or bruising appear or worsen, a repeat CBC and discussion with a primary care clinician may be appropriate. People with prior chemotherapy or radiation exposure, smoking history, or certain environmental exposures may benefit from closer monitoring. Not all abnormalities signal MDS or leukemia—many are reversible—but tracking trends over time supports timely referrals to hematology when needed.

In summary, paying attention to quiet signals—especially when they persist or progress—can prompt timely evaluation. Thoughtful testing, starting with blood counts and, when needed, bone marrow assessment, can differentiate reversible causes from marrow disorders. With risk-tailored treatment plans and day-to-day strategies that conserve energy and limit infection or bleeding risks, many people can maintain function while their care team monitors changes over time.