This puts them at high risk of transfusion-induced iron overload as indicated by high serum ferritin (SF) levels.11 Furthermore, iron overload in MDS may start before patients become transfusion-dependent because of ineffective erythropoiesis that suppresses hepcidin production and increases intestinal iron absorption.12 Moreover, chronic inflammatory reaction results in a high SF level, which is commonly observed in MDS.13 Iron-chelating agents may be of help in ameliorating the iron overload and its manifestations. This evidence concerns the gene HAMP and Tangier disease.