Supportive care

Supportive care is administered to most patients with MDS with the aim of reducing morbidity and maintaining quality of life. For many if not most patients this will be the mainstay of management.

Red cell transfusion should be administered for symptomatic anaemia; individual symptomatology rather than 'trigger' level should initiate red cell support.

230 Iron chelation therapy should be considered once a patient has received 25 units of RBCs if long term transfusion is likely e.g. pure sideroblastic anaemia or 5q- syndrome; Desferrioxamine 20-40mg/kg by 12h SC infusion 5-7 nights/week reduced to 25mg/kg when ferritin <2000mg/L; vitamin C 100-200mg/day PO may be added after 1 month; audiometric and ophthalmological assessments prior to therapy and annually; aim for serum ferritin <1000mg/L.

Platelet transfusion should be administered for patients with haemorrhagic problems and those with severe thrombocytopenia with the aim of maintaining a platelet count >10 x 109/L.

Anti-infective therapy i.e. empirical broad spectrum antibiotics and/or antifungals should be administered promptly for neutropenic sepsis; no evidence to support routine use of prophylactic anti-infectives in neutropenic patients; prophylactic anti-infective agents may be useful in neutropenic patients with recurrent infection.

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