HAMP and myelodysplastic syndrome: Thus, patients with MDS are at risk for IO prior to their becoming transfusion dependent, due to the disease processes seen in MDS, which results in reduced hepcidin production by the liver and increased iron absorption from the gut, ultimately leading to IO (Figure 1B; Chaudhary & Pullarkat, 2013; Sebastiani et al., 2016; Steensma & Gattermann, 2013).