Red Blood Cell (RBC) transfusion dependence is a prevalent consequence of anaemia in patients with lower risk Myelodysplastic Syndromes (MDS). These patients have shorter survival compared to patients responding to Erythropoiesis-stimulating agents (ESA), raising the question of potential negative effects of chronic RBC transfusions on MDS prognosis, independently of IPSS-R. Besides commonly identified complications of transfusions like iron toxicity or cardiac events, oxidative stress could be a risk factor for ineffective haematopoiesis. Recently, physicochemical changes of RBC during storage have been described. These changes called storage lesions could play a role in immunomodulation in vivo. We review the currently identified sources of potential impact on transfusion-associated effects in MDS patients and we discuss the unexplored potential role of erythrocyte-derived-extracellular vesicles. They could amplify impairment of haematopoiesis in addition to the negative intrinsic effects underlying the pathology in MDS. Thus, chronic RBC transfusions appear to potentially impact the outcome of MDS.

红细胞（RBC）输血依赖性是低风险骨髓增生异常综合征（MDS）患者贫血的普遍结果。与对红细胞生成刺激剂（ESA）有反应的患者相比，这些患者的生存期较短，这提出了慢性RBC输注对MDS预后的潜在负面影响（独立于IPSS-R）的问题。除了通常确定的输血并发症，如铁毒性或心脏事件外，氧化应激可能是造血无效的危险因素。最近，已经描述了在储存过程中红细胞的理化变化。这些称为存储损伤的变化可能在体内免疫调节中起作用。我们审查了当前确定的对MDS患者输血相关效应的潜在影响的来源，并讨论了红细胞衍生的细胞外囊泡的未探索的潜在作用。除了可能导致MDS病理学的负面内在作用外，它们还可以扩大造血功能的损害。因此，慢性RBC输血似乎可能影响MDS的预后。