Anemia is a multifactorial condition and several determinants may contribute to its pathogenesis, including failure of appropriate erythropoietin (EPO) production or EPO resistance, damage to EPO-producing peri-tubular cells, decreased proliferative capacity of bone marrow stem cells, impaired renal function, myelodysplasia, testosterone deficiency, chronic inflammation, iron deficiency, use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) affecting EPO production, use of metformin, causing malabsorption of vitamin B12, or pioglitazone. Here, EPO is linked to Myelodysplasia.