In May 2005 at the 8th International Symposium on Myelodysplastic Syndromes (MDS), a consensus meeting was held on iron overload in MDS (Seymour, Hematol Oncol Clin 2005; Suppl 1:18-25). The recommendations of the 2005 consensus meeting were discussed in the context of currently available evidence at the 9th International Symposium on Myelodysplastic Syndromes in Florence Italy, May 2007. The recommendations of the consensus working group are presented here. The recommendations are a continued refinement of the outcome of the 2005 consensus meeting and the ground-breaking work of others in this area (Seymour, Hematol Oncol Clin 2005; Suppl 1:18-25; Gattermann, Int J Hematol 2008;88:24-29; Alessandrino et al., Haematologica 2002;87:1286-1306; NCCN practice guidelines: Myelodysplastic Syndromes, version 2.2008). Am. J. Hematol. 83:858-861, 2008. (C) 2008 Wiley-Liss, Inc.