PURPOSE: To search complement system activity and detection of circulating immune complexes in a group of patients with myelodysplastic syndromes (MDS) classified as with relatively favourable and unfavourable prognosis. PATIENTS AND METHODS: 28 patients with MDS were examined, 12 with refractory anaemia and 4 with refractory ringed sideroblastic anaemia, both subgroups of relatively favourable prognosis; 9 patients with refractory anaemia with blastic excess and 3 with refractory anaemia with blastic excess in transformation, subgroups of unfavourable prognosis. We determined factor B, alternate and classical hemolytic activity, as well as C3 and C4 quantification of the complement system. Circulating immune complexes detection was performed by the C1q deviation test and polyethylene glycol 6000 precipitation method at 3.75% final concentration. RESULTS: A significant decrease in C3 level, alternate haemolytic activity and factor B was demonstrated in the unfavourable prognosis subgroups in comparison with patients of favourable prognosis and normal controls. CONCLUSIONS: Our results suggest the possibility of subclinical infections in patients with unfavourable prognosis.