I would code 238.75 MDS unspecified, 287.49 secondary thrombocytopenia and 285.22 anemia in neoplastic disease.
My reasoning is that the definition of thrombocytopenia is the deficiency of platelets in the blood. The definition of anemia is the deficiency of red blood cells, hemoglobin and/or total volume in the blood. Different definitions and the lack of a coding guideline with these codes directing not to use both, makes me confident that these are two distinct conditions that required their own code to accurately describe the total condition of the patient.
I chose the "secondary" and "in neoplastic disease" codes because the word "with" is indicative that the thrombocytopenia and anemia are in direct relation and caused by the MDS.
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