Myelodysplastic syndrome with multilineage dysplasia

ICD-O-3 Morphology

9985/3: Myelodysplastic syndrome with multilineage dysplasia
Effective 2001 and later


for cases diagnosed 2001 and later

Primary Site(s)

Primary site must be bone marrow (C421)

Abstractor Notes

Blood and bone marrow are always involved. At least 2 types of blood counts are low and have an abnormal appearance under the microscope (dysplasia). The number of blasts is less than 5%.

This histology code also includes childhood MDS. MDS is very rare in children. Both the peripheral blood and bone marrow are involved.

For MDS diseases (9980, 9982, 9983, 9985, 9986, 9989, 9991, 9992, 9993), 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.

Diagnostic Confirmation

This histology can be determined by positive histology (including peripheral blood) with or without genetics and/or immunophenotyping. Review the Definitive Diagnostic Methods, Immunophenotyping and Genetics Data sections below, and the instructions in the Hematopoietic Manual for further guidance on assigning Diagnostic confirmation.


Not Applicable

Module Rule


Alternate Names

Refractory cytopenia of childhood
Refractory cytopenia with multilineage dysplasia


Myelodysplastic syndrome (MDS) with multilineage dysplasia (MDS-MLD), is an MDS characterized by one or more cytopenias and dysplastic changes in two or more of the myeloid lineage (erythroid, granulocytic, and megakaryocytic).

Definitive Diagnostic Methods

Bone marrow biopsy
Genetic testing

Genetics Data

del (5q)
del (7q)
del (20q)
Monosomy 5
Monosomy 7
Trisomy 8




Hematologic Transplant and/or Endocrine Procedures

Transformations from


Corresponding ICD-9 Codes

238.72 Low grade myelodysplastic syndrome lesions

Corresponding ICD-10 Codes

D46.7 Other myelodysplastic syndromes

Corresponding ICD-10-CM Codes (U.S. only)

D46.A Refractory cytopenia with multilineage dysplasia (effective October 01, 2015)

Signs and Symptoms

Cytopenia (of two or more myeloid lines)
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

Diagnostic Exams

Blood chemistry studies
Cytogenetic analysis
FISH (flourescence in situ hybridzation)
Flow cytometry
Peripheral blood smear

Progression and Transformation

~10% of cases evolve to AML in 2 years

Epidemiology and Mortality

Age (Adult): 70 years median age
Age (Childhood): all age groups
Incidence (Adult): accounts for ~30% of MDS cases
Incidence (Childhood): most common MDS of childhood, ~50%
Sex (Adult): slight male predominance
Sex (Childhood): no male or female predominance
Survival: 30 month median survival (~1/2 of patients died within 2 years)


Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds):
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Myelodysplastic syndromes
Pages: 111-113, 116-120

International Classification of Diseases for Oncology, Third Edition, Second Revision. Geneva: World Health Organization, 2020.
Section: ICD-O-3.2 (2020) Morphological Codes

National Cancer Institute
Section: General Information About Myelodysplastic Syndromes