Oncology & Hematology Coding Alert

MDS refers to a condition where orderly and controlled production of blood cells in the bone marrow is disrupted. As a result, the blood cells are immature and defective. These cells may either die in the bone marrow or in the bloodstream soon after leaving the bone marrow. “MDS is often referred to as a “bone marrow failure disorder.” according to the MDS Foundation. MDS is primarily a disease of the elderly (most patients are older than age 65), but MDS can affect younger patients as well.”

Over time, the number of immature, defective cells begins to surpass that of healthy blood cells, leading to problems such as anemia, infections and excess bleeding.

Myelodysplastic syndrome is divided into subtypes based on the type of blood cells — red cells, white cells and platelets — involved, the American Cancer Society clarifies. 

Here’s how the World Health Organization (WHO) classification is divided: 

• Refractory cytopenia with unilineage dysplasia (RCUD): In this type of MDS, any one cell type is low in number. This can manifest as refractory anemia (RA), refractory neutropenia (RN), and refractory thrombocytopenia (RT). The blood cells also may have an abnormal appearance under the microscope. RA is anemia that does not respond to therapy. The only possible treatment that your physician may use in RA is blood transfusion.
• Refractory anemia with ringed sideroblasts (RARS): In this type of MDS, the red blood cells are low in number and contain excess amounts of iron. Under the microscope, this excess iron is seen as a ring.
• Refractory cytopenia with multilineage dysplasia (RCMD): There are low counts of two types of blood cells. The cells are abnormal in appearance. Very early immature cells (called blast cells) are also seen. 
• Refractory anemia with excess blasts — types 1 and 2 (RAEB-1 and RAEB-2): Any of the three types of blood cells — red blood cells, white blood cells or platelets — may be low in number. Additionally, the cells appear abnormal under a microscope. Blasts also appear in blood.
• Myelodysplastic syndrome, unclassified (MDS-U): This type of MDS is uncommon. Diagnosis is made when a definitive diagnosis of any other type of MDS cannot be made. 
• Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality. The numbers of red blood cells are low. The cells have part of chromosome 5 missing. 

Resource: Read more about MDS at http://www.cancer.org/cancer/myelodysplasticsyndrome/index.