Q: My girlfriend has been diagnosed with myelodysplastic syndrome - refractory anaemia. The doctor has put her on blood transfusion (1 unit per week on average). At her young age of 27 is this a normal situation to lose so much blood? Are there any Ayurvedic medication or doctors that can help? What are the things that have to be done to find out the real cause of this problem?

A:Myelodysplastic syndromes (MDS) are a varied group of haematologic disorders arising from a problem in the stem cells. They are characterised by ineffective blood cell production resulting in varying degrees of anaemia (low haemoglobin), leukopaenia (reduced white cell count) and thrombocytopaenia (low platelets). The bone marrow and peripheral blood examination shows cells with abnormal features. The postulated causes include prior chemotherapy, exposure to radiation or chemicals, viral infection or genetic predisposition. The condition is considered to be a premalignant one as some forms of MDS may transform to leukaemia. Most treatment of MDS is not standard and is considered experimental and is constantly changing. It is based on the stage and mechanism of the disease that predominates. In the early phases of ineffective haematopoiesis, retinoids and haematopoietic growth factors are indicated. In late stages, with inevitable leukaemic transformation, cytotoxic chemotherapy and bone marrow transplantation may be necessary. All of these modes of therapy are undergoing clinical trials to determine the overall benefit to quality of life and survival. Supportive therapy like transfusions of the cells that are low (red cells or platelets), and treatment of infections form the cornerstone. Symptomatic therapy improves quality of life but these measures are temporary and more long-term measures are necessary to stimulate the patients’ bone marrow. These include erythropoietin for anaemia and granulocyte colony-stimulating factor for neutropaenia. Transition to acute leukaemia is prevented by administration of the newly approved demethylating agent azacitidine. New promising drugs such as Revimid are completing clinical trials. Patients who have a single or mild cytopenias, normal chromosomes or a single chromosomal abnormality (except those involving chromosome 7), and less than 5% myeloblasts in the bone marrow have a better prognosis.