Most MDS patients are elderly and present with symptoms of anemia. The family doctor may suspect B deficiency because of the combination of anemia and macrocytosis. However, the anemia does not respond to B or other vitamins and is by definition refractory. Occasionally patients may present more dramatically with a severe infection or, even more uncommonly, with hemorrhage. The typical laboratory finding is of peripheral blood cytopenia and a hypercellular bone marrow. Of course, secondary MDS may present at any age consequent on chemotherapy for a primary tumor. Overall, the sex ratio of patients with MDS is equal, but the 5q- syndrome has a particular female preponderance and CMML has a male preponderance.
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