Some people with MDS are asymptomatic with no signs or symptoms identified with cytopenia on routine blood testing. The monitoring strategy includes excluding reversible causes and referral if they persist. Many people with MDS have a combination of symptoms. This is because the production of some or all of the blood cell types may be affected by the disease.
The following signs and symptoms should be investigated (Bewersdorf et al. 2020):

• persistent tiredness and fatigue
• weakness
• shortness of breath with minimal exercise
• looking pale
• recurring infections, especially chest infections
• fevers
• sore mouth due to mouth ulcers
• easy bruising
• purpura – a rash of small red dots, seen often on the lower limbs initially, due to small superficial capillary bleeds known as petechiae
• tendency to bleed from the nose and gums.

The presence of multiple signs and symptoms, particularly in combination with other underlying risk factors, indicates an increased risk of MDS.