Inclusion Criteria:  Age ≥ 18 years of age Diagnosis of MDS (Myelodysplastic syndrome ) without leukemia (IPSS-R classified or physician indicated either low-risk or intermediate-1) Stable disease (as assessed by the patient's physician using MDS Stability Assessment Algorithm) Blood group A, B, or AB Requiring 2 RBC units at least every 6 weeks or less Receiving transfusions in an outpatient setting  Exclusion Criteria:  Unable to provide informed consent Blood group O Clinical requirement for special products because of reactions (e.g. washed or volume-reduced)