Myelodysplastic syndromes and utilisation of blood products in the era of hypomethylating agents

Myelodysplastic syndromes (MDS) are primary bone marrow disorders with clonal abnormalities in hematopoietic stem cells. It leads to ineffective hematopoiesis causing cytopenias as well as functional abnormalities. There is inherent risk of transformation to acute leukemias. Patients are primarlity managed by supportive treatment including blood product transfusion and antibiotics. Blood product transfusions have associated complications secondary to circulatory overload, iron overload, risk of infections and development of antibodies. Depending on the IPSS, low and intermediate -1 patients with iron overload are commenced on iron chelation therapy. Hypomethylating agents have been available for intermediate 2 to high risk MDS patients with the expectation to improve overall survival and reduce transfusion requirements.