Abstract In a period of 2 years, 48 patients over age 55 were treated for acute myeloblastic leukaemia or myelodysplastic syndrome with greater than 10% blasts. 15 patients were treated with intestine chemotherapy, requiring a mean of 48 units of platelets per course. 33 patients were treated by supportive care alone of whom 19 required a mean of 380 units of platelets each. Long term supportive care is a feasible option in elderly leukaemia. Because of dysplasia some patients bleed at a higher threshold than younger patients. A further hazard is the use of i.v. hydrocortisone to suppress transfusion reactions. Such unintentional use of steroids in patients with dysplastic neutrophiles and monocytes may predispose to fungal infections.