Refractory anemia

ICD-O-3 Morphology
Effective 2001 and later
for cases diagnosed 2001 and later
Primary Site(s)
Primary site must be bone marrow (C421)

Not Applicable
Module Rule
Alternate Names
Aregenerative anemia
RA is any of a group of anemic conditions not associated with another disease and is marked by a persistent, frequently advanced anemia that can only be successfully treated with blood transfusions. RA is only anemia.

The early cells that develop into red blood cells have an abnormal appearance (called dysplasia). The number of very early cells (called blasts) is normal (less than 5%).

The peripheral blood smear usually shows normochromic, normocytic, or normochromic macrocytic. Blasts are rarely seen and, if present, account for <1% of the white blood cells.

The erythroid precursors in the BM vary from decreased to markedly increased. The BM must show unequivocal evidence of dysplasia (dysplasia must be present in 10% or more erythroid precursors). Ring sideroblasts may be present. The BM biopsy is generally hypercellular.
Abstractor Notes
Refractory anemia (RA) is a specific type of myelodysplastic syndrome that is characterized mainly by unilineage dysplasia affecting erythroid series. (Diagnosis of exclusion).

The principle sites of involvement are the peripheral blood and bone marrow.

There should be a period of observation of six months followed by a re-evaluation before a definitive diagnosis of RA is established.

For MDS diseases (9980, 9982, 9983, 9985, 9986, 9989, 9991, 9992), abstracting each of the subtypes would result in over-counting of the diseases.
1. Code only the first subtype that is diagnosed.
2. Do not change the histology code or create a new abstract for any subsequent specific MDS subtypes.
Definitive Diagnostic Methods
Bone marrow biopsy
Clinical diagnosis
Genetics Data
Bone marrow transplant
Stem cell transplant
Transformations from
Corresponding ICD-9 Codes
238.72 Low grade myelodysplastic syndrome lesions
Corresponding ICD-10 Codes
D46.4 Refractory anemia, unspecified
Corresponding ICD-10-CM Codes (U.S. only)
D46.4 Refractory anemia, unspecified (effective October 01, 2015)
Signs and Symptoms
Easy bruising or bleeding
Petechiae (flat, pinpoint spots under the skin caused by bleeding)
Shortness of breath
Skin paler than usual
Weakness or feeling tired
Progression and Transformation
1-2% of cases evolve to AML
Epidemiology and Mortality
Age: 65-70 years median age
Incidence: 10-20% of all MDS cases
Sex: no male or female predominance
Survival: 69-108 median survival time