A 57-year-old man with a history of diabetes and coronary artery disease was referred to haematology for the evaluation of anaemia in the setting of non-cardiac chest pain, fatigue, dyspnoea and dizziness. Previous investigations into these recurrent symptoms focused on a re-evaluation of his known ischaemic heart disease, which required multiple percutaneous interventions with stenting several years ago. In the year leading up to his referral, the patient required two transfusions during separate hospitalisations. Previously, his chronic anaemia was attributed to chronic inflammation because of unrevealing micronutrient and endoscopic evaluations. The patient underwent a bone marrow biopsy, which demonstrated normal karyotype myelodysplastic syndrome with ringed sideroblasts. This patient was found to have favourable cytogenetics and low-risk disease. His anaemia and associated symptoms improved with the administration of an erythroid-stimulating agent. Now 75 years old, he has remained on single-agent therapy for 10 years without need of transfusion.