Abstract: Objective To investigate the iron overload and its influencing factors in patients with aplastic anemia (AA). Methods A total of 200 adult AA patients were selected in Department of Hematology of the First Hospital of Ningbo, the Second Hospital of Ningbo City and the Fuyang Hospital Affiliated to Anhui Medical University from March, 2014 to March, 2018. The clinical data of patients were collected. The serum ferritin (SF) levels were measured by radioimmunoassay. The levels of total iron binding force (TIBC) and serum iron (SI) were determined by the colorimetric method of ferrozine. The levels of soluble transferrin receptor (sTfR) and transferrin (Tf) were determined by immunoturbidimetry. The transferrin saturation (TS) was calculated. Results In 200 patients with AA, the SF was 1 253.25(519.06, 1 757.17) μg/L, SI was 33.31 (21.60, 56.66) μmol/L, TS was 62.02%(30.88%, 74.60%), the Tf was 1.87 (1.60, 2.71)g/L, and the sTfR was 0.93 (0.54, 2.10)mg/L. In 200 patients with AA, iron overload occurred in 29 patients, with an overload rate of 14.5%. The proportion of iron overload in males, heavy AA, blood transfusion >8 U and coinfection were higher than that of without iron overload (P<0.05). The age, etiology and course of disease were not associated with iron overload in AA (P>0.05). Logistic regression analysis showed that men, blood transfusion >8 U and coinfection were independent risk factors for iron overload in AA (P<0.05). Conclusion The incidence of iron overload in AA patients is high. Males, blood transfusion >8 U and coinfection are independent risk factors for iron overload in AA patients.