Objective： To investigate the correlation between bone marrow cell morphological abnormalities and serum ferritin levels in patients with myelodysplastic syndrome, providing reference for clinical diagnosis and prognostic evaluation. Methods: 100 MDS patients admitted to Nantong Tongzhou District People's Hospital from January 2021 to December 2023 were selected as research subjects. Bone marrow cell morphological characteristics were observed using an Olympus CX31 microscope, routine blood parameters were detected using a Mindray BC7500 blood cell analyzer, and serum ferritin levels were measured by electrochemiluminescence immunoassay. Data analysis was performed using SPSS 25.0 statistical software. Results: A significant positive correlation was found between the percentage of bone marrow blast cells and serum ferritin levels (r=0.642, P<0.01); the proportion of ring sideroblasts also showed a significant positive correlation with serum ferritin levels (r=0.583, P<0.01). Patients with severe bone marrow morphological abnormalities had significantly higher serum ferritin levels compared to those with mild to moderate abnormalities (P<0.05). Conclusion: The degree of bone marrow cell morphological abnormalities is closely correlated with serum ferritin levels in MDS patients. Combined detection has important clinical value in evaluating disease progression.