In the early stages of myelodysplastic syndrome (MDS), patients may not have any symptoms. As the disease slowly progresses, patients may develop definite symptoms when blood counts fall significantly below normal levels. MDS needs to be considered and identified when these symptoms occur as follows Recurrent and uncorrectable anemia At the time of the initial diagnosis of MDS, most patients have anemia. Anemia manifests itself primarily as a persistent decrease in red blood cell count or a persistent decrease in hemoglobin. Patients with anemia often experience fatigue and weakness. The symptoms of anemia are related to the severity of the anemia. Patients with mild anemia may feel well or feel only mildly fatigued. Almost all patients with moderate anemia will experience some degree of fatigue and may have palpitations, shortness of breath and pale skin. In patients with severe anemia, almost all have pallor, chronic excessive fatigue and shortness of breath. Because severe anemia reduces the blood supply to the heart, older patients may be more likely to have cardiovascular symptoms, including chest pain. Although chronic anemia is rarely life-threatening, it can still significantly reduce a patient’s quality of life. When anemia occurs that cannot be treated by nutrient supplementation, or when hemolytic or blood loss anemia has been ruled out, and the condition recurs for more than a few months or even longer, consider that it may be related to abnormal bone marrow hematopoietic development and MDS should be highly suspected. Persistent leukopenia with recurrent infections A low white blood cell count reduces the body’s resistance to bacterial infections. Patients with neutropenia may be susceptible to skin infections, sinus infections (symptoms include nasal congestion), lung infections (symptoms include cough and shortness of breath), or urinary tract infections (symptoms include frequent and painful urination). These infections may be accompanied by fever. leukopenia in patients with MDS is often not treated with the usual oral leukocyte-raising drugs. Persistent or progressive thrombocytopenia with recurrent gum bleeding Patients with thrombocytopenia have an increased chance of petechiae and bleeding, even from only minor bumps and bruises. Nasal bleeding is more common, and patients often experience gum bleeding, especially after dental treatment. Because infection and bleeding pose a risk for most patients with MDS, we recommend that you consult your hematologist before undergoing dental treatment, and they may recommend prophylactic antibiotics. Patients with MDS often present with thrombocytopenia that is difficult to correct. When severe thrombocytopenia occurs, such as platelets below 10,000/ul (or less than 10 x 109/L), patients are at greatly increased risk for bleeding and generally require hospitalization.