Patient: MDS-RAEB, mainly treated with Chinese herbal medicine, oral medicine is Yi kidney blood tablets, Qing Huang San, testosterone undecanoate pills, blood transfusion once a month, recent blood test serum iron 54, the normal index is 8 – 26, ALT is 59, the normal index is 0 – 45. -What medication should be used? Is the high ALT related to iron overload or to the use of testosterone undecanoate pills? How to lower it? Tong Hongyan, Department of Hematology, The First Hospital of Zhejiang Province: Iron overload in patients receiving repeated transfusion therapy, especially in red blood cell transfusion-dependent MDS patients, can lead to a shorter overall survival if no treatment is taken or improper treatment is given. Therefore, iron removal therapy is required. Generally, iron removal therapy should be considered when the serum ferritin (SF) is greater than 1000. In patients who are dependent on red blood cell transfusion, SF should be monitored 3–4 times a year, and in patients receiving iron removal therapy, iron load should be monitored according to the guidelines for the use of the selected drug and the function of the involved organs should be evaluated regularly. The effectiveness of iron removal therapy, which can reduce SF levels and iron levels in the liver and heart, depends on the duration of drug administration, dose, patient tolerance, and the amount of blood transfused at the same time; iron removal therapy can be discontinued when the SF falls below 500 μg/L and the patient no longer requires blood transfusions, or when iron removal therapy is no longer the patient’s maximum benefit. Commonly used drugs include iron chelating amine, iron chelating ketone, and deferasirox.