Up to 90% of people with MDS will need red blood cell transfusions to treat symptoms of anemia. As many as 50% will need platelet transfusions to treat thrombocytopenia.

Myelodysplastic syndromes (MDS) are a group of disorders that affect the way new blood cells are produced in your bone marrow.

People with MDS have fewer red blood cells, which carry oxygen to your tissues, and platelets, which stop the bleeding when you’re injured.

If your doctor has said that you need blood transfusions to treat MDS, here’s what to expect.

New red blood cells and platelets are made in your bone marrow, the spongy tissue inside bones. Damage from MDS prevents the bone marrow from making enough healthy red blood cells and platelets.

Having too few red blood cells is called anemia. It causes symptoms like fatigue, shortness of breath, and heart palpitations. Having too few platelets is called thrombocytopenia. It makes you bruise or bleed more easily.

Transfusion typeWhy it’s doneWhen to have it
Red blood cells to improve anemia symptoms like fatigue and shortness of breath, and to prevent complications of anemiaif your hemoglobin and hematocrit levels are low, you have anemia symptoms like fatigue and weakness, or both
Plateletsto improve symptoms like bruising and bleeding and to prevent complications of thrombocytopeniaif you’re experiencing abnormal bleeding or have a low platelet count

The frequency of blood transfusions for MDS depends on your red blood cell and platelet counts.

Some people with MDS need transfusions every couple of weeks. Others can go months without needing a transfusion. Platelet transfusions are needed more often because these blood cells can only survive for 7 to 10 days.

Your doctor will monitor your red blood cells and platelet counts, and they’ll let you know how often you need transfusions based on these test results.

The blood you’ll receive during transfusions comes from a healthy donor. First, your blood type and the donor’s blood type are tested to make sure they match. Getting a blood type that doesn’t match your own could cause a dangerous reaction.

These are the steps involved in a blood transfusion:

  1. A technician disinfects the skin before using a needle to place an intravenous (IV) line into a blood vessel, usually in your arm.
  2. The donor blood drips from a bag through the IV line into your blood vessel. This process is called transfusion. You’ll be watched closely during at least part of this time to make sure you don’t have a reaction.
  3. After enough blood has been transfused, the technician removes the IV line and checks your vital signs, such as temperature, heart rate, and blood pressure.

Where are they performed?

Most blood transfusions are done in a hospital, clinic, or doctor’s office. In some cases, visiting nurses can give transfusions in people’s homes.

How long do they take?

A blood transfusion takes between 1 to 4 hours, depending on how much blood you need and which types of blood cells you are receiving. A platelet transfusion is generally a faster process than a red blood cell transfusion — around 30 minutes to 1 hour.

Blood transfusions are part of supportive care for MDS. They help to relieve anemia symptoms, like fatigue and weakness, and thrombocytopenia symptoms, such as bruising and bleeding. Transfusions can also prevent anemia complications like heart failure and heart attack.

This treatment can be helpful for people who don’t improve enough after treatments like growth factors, immunomodulators, and other MDS medications. Blood transfusions can also be a short-term treatment for a low blood cell count caused by a medication you take.

Blood transfusions are considered very safe. In the past, donated blood could harbor infections like HIV and hepatitis. Thanks to donor screening and testing of the blood supply, these infections are rare today.

The odds of getting HIV from a transfusion are 1 in 2 million. The risk of getting hepatitis C from a transfusion is 1 in 1.5 million.

Reactions are the main worry with blood transfusions. There are different types of reactions, and some are more serious than others. They can happen within minutes to days after the transfusion and include:

  • Allergic reactions: This is the most common type of blood transfusion reaction. It happens when your body reacts to certain proteins or other substances in donated blood. Symptoms include hives and itching, which you can usually treat with antihistamines.
  • Acute immune hemolytic reactions: This very serious reaction happens when your blood type and your donor’s blood type don’t match. Your immune system attacks the new red blood cells, which makes them break open and release toxins into your blood. Acute immune hemolytic reactions are rare today because donors and recipients are matched so carefully, but if you do have this type of reaction, your technician will stop the transfusion immediately.
  • Transfusion-related acute lung injuries (TRALI): Rarely, the transfusion activates immune cells in the lungs, which causes fluid buildup and lung damage. TRALI is more common in people who are already very sick. If you have trouble breathing, which is a symptom of TRALI, your technician will stop the transfusion.

Iron overload is another possible, less immediate risk. Blood contains iron, and after you’ve had about 20 transfusions, iron can build up in organs like your liver or heart and damage them. If this happens, you may need a special treatment called chelation therapy to help your body get rid of the extra iron.

Some people become dependent on blood transfusions, which means they need two or more red blood cell transfusions a month. Being dependent on transfusions can lead to worse health outcomes.

Caring for MDS is expensive, especially if you need transfusions. If you have insurance, the costs will differ based on the plan you have.

Speak with your doctor or ask them to connect you with a member of their office staff who can help you understand your out-of-pocket costs for transfusions.

According to one 2013 study, the yearly medical cost of managing MDS in people who didn’t need transfusions was about $9,800 to $19,800. For people who did need transfusions, the costs were about double — $29,600 to $51,000.

These numbers estimate the total value of the medication used, infusions given, and other healthcare expenses, so they don’t necessarily reflect what an individual with insurance coverage would pay. Also, given the year the study was published, costs today are likely higher due to inflation.

MDS treatments come in two types: supportive care and drug therapy.

Blood transfusions are a type of supportive care. They reduce symptoms but don’t slow the disease.

Growth factors are another supportive treatment that helps your bone marrow make new blood cells. They may reduce your need for transfusions.

These growth factors help your body make more red blood cells:

  • epoetin (Epogen, Procrit)
  • darbepoetin alfa (Aranesp)
  • luspatercept (Reblozyl)

These growth factors help your body make more platelets:

  • romiplostim (Nplate)
  • eltrombopag (Promacta)

These are some other treatments that may reduce the need for transfusions:

  • lenalidomide (Revlimid)
  • antithymocyte globulin (ATG), an immune-suppressing medication
  • chemotherapy drugs like azacitidine (Vidaza) or decitabine (Dacogen)

Transfusions give you the red blood cells and platelets that your body is missing with MDS, helping to relieve MDS symptoms.

The downsides are that transfusions are expensive and they have some potential side effects, including reactions and iron overload.

Other MDS treatments, such as growth factors and immune-suppressing medications, may help reduce your need for transfusions.