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MDS is first suspected when there is a low blood count on a blood test. If your doctor suspects that you have MDS, they will recommend for you to undergo a bone marrow biopsy to confirm the diagnosis. From the bone marrow sample, we will look at the appearance of the early cells under the microscope to see if they appear abnormal. This is called dysplasia. They will then decide the number of types of blood cells that have dysplasia, percentage of cancer cells (or blasts) and presence or absence of chromosome abnormalities or gene mutations, to estimate the likelihood of the condition transforming to AML.