The perils of not digging deep enough—uncovering a rare cause of acquired anemia

Saini, Neeraj; Jacobson, Joseph O.; Jha, Smita; Saini, Vivek Kumar; Weinger, Ronald S.

doi:10.1002/ajh.22235

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Today, a similar process has been noted with toxicity to the antibiotics linozolid and certain tetracyclines. This finding has been also described with arsenic poisoning and copper deficiency where it may affect both myeloid and erythroid cells and is well known as a consequence of alcohol-induced hematological toxicity along with ringed sideroblasts [21, 23, 24, 45]. Importantly, it is highly unlikely to be the primary or sole feature of MDS, as in our Case 3, and its presence should immediately suggest a medication review and a search for a possible recent bone marrow toxic exposure.…”

Section: Resultsmentioning

confidence: 63%

“…As discussed in the previous section, reversible sideroblastic anemias may occur in a number of circumstances including prolonged use of certain antibiotics such as chloramphenicol, linezolid, pyrazinamide, isoniazid, rifampin, and some tetracyclines [24, 25]. In this group the myelodysplasia that results may from time to time also be associated with the acquired or pseudo Pelger-Huët anomaly of abnormal granulocyte nuclear segmentation.…”

Section: Resultsmentioning

confidence: 99%

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Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog

Natelson

Pyatt

2013

Advances in Hematology

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Myelodysplastic syndromes (MDS) are clonal myeloid disorders characterized by progressive peripheral blood cytopenias associated with ineffective myelopoiesis. They are typically considered neoplasms because of frequent genetic aberrations and patient-limited survival with progression to acute myeloid leukemia (AML) or death related to the consequences of bone marrow failure including infection, hemorrhage, and iron overload. A progression to AML has always been recognized among the myeloproliferative disorders (MPD) but occurs only rarely among those with essential thrombocythemia (ET). Yet, the World Health Organization (WHO) has chosen to apply the designation myeloproliferative neoplasms (MPN), for all MPD but has not similarly recommended that all MDS become the myelodysplastic neoplasms (MDN). This apparent dichotomy may reflect the extremely diverse nature of MDS. Moreover, the term MDS is occasionally inappropriately applied to hematologic disorders associated with acquired morphologic myelodysplastic features which may rather represent potentially reversible hematological responses to immune-mediated factors, nutritional deficiency states, and disordered myelopoietic responses to various pharmaceutical, herbal, or other potentially myelotoxic compounds. We emphasize the clinical settings, and the histopathologic features, of such AMD that should trigger a search for a reversible underlying condition that may be nonneoplastic and not MDS.

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Section: Resultsmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 99%

Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog

Natelson

Pyatt

2013

Advances in Hematology

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“…Indeed, some of their characteristics may overlap with those of congenital or acquired clonal forms. Agents known in the literature to produce metabolic sideroblastic anemia are listed below ( Table 3 ): exposure to toxic substances (alcohol use [ 29 ], heavy metal intoxication (lead [ 30 ], arsenic, mercury), benzene exposure, drugs (anti-tuberculosis: isoniazid, pyrazinamide [ 31 ], cycloserine), antibiotics (chloramphenicol, D-penicillamine, linezolid [ 32 , 33 , 34 ], lincomycin, cefadroxil, fusidic acid [ 35 ], tetracyclines), cancer chemotherapy (chlorambucil, busulfan, melphalan, lenalidomide [ 36 ] ( Figure 5 )), malnutrition/deficiency in nutrition or other metabolic disorders (vitamin B1, B6, B9, B12 deficiencies, copper deficiency [ 37 , 38 ], prolonged parenteral nutrition, gastric surgery, and zinc overdose [ 31 ]). The action of these agents is to inhibit steps in the heme biosynthetic pathway.…”

Section: The Different Forms Of Sideroblastic Anemiamentioning

confidence: 99%

When Ring Sideroblasts on Bone Marrow Smears Are Inconsistent with the Diagnosis of Myelodysplastic Neoplasms

et al. 2022

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Ring sideroblasts are commonly seen in myelodysplastic neoplasms and are a key condition for identifying distinct entities of myelodysplastic neoplasms according to the WHO classification. However, the presence of ring sideroblasts is not exclusive to myelodysplastic neoplasms. Ring sideroblasts are as well either encountered in non-clonal secondary acquired disorders, such as exposure to toxic substances, drug/medicine, copper deficiency, zinc overload, lead poison, or hereditary sideroblastic anemias related to X-linked, autosomal, or mitochondrial mutations. This review article will discuss diseases associated with ring sideroblasts outside the context of myelodysplastic neoplasms. Knowledge of the differential diagnoses characterized by the presence of ring sideroblasts in bone marrow is essential to prevent any misdiagnosis, which leads to delayed diagnosis and subsequent management of patients that differ in the different forms of sideroblastic anemia.

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Be careful of the masquerades: differentiating secondary myelodysplasia from myelodysplastic syndromes in clinical practice

Shallis

Podoltsev

et al. 2018

Ann Hematol

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In patients suspected to have myelodysplastic syndrome (MDS), especially in those patients without cytogenetic abnormalities or blast excess, accurate morphologic review by an expert hematopathologist and meticulous exclusion of other secondary causes of myelodysplasia are vital to establish the diagnosis. Errors in diagnosis can lead to dangerous consequences such as the administration of hypomethylating agents, lenalidomide, or even the use of intensive chemotherapy or allogeneic hematopoietic cell transplantation in patients who do not have an underlying MDS or even a malignant hematopoietic process. Additionally, beyond the possible harm and lack of efficacy of such therapies if the diagnosis of MDS is erroneous, the secondary myelodysplasia and resultant cytopenias are not likely to resolve unless the underlying etiology is identified and addressed. Discriminating a malignant process such as MDS from non-malignant secondary myelodysplasia can be quite challenging, and community hematologists/oncologists should consider referral to specialized physicians (both clinical experts and experienced hematopathologists) if there is any doubt regarding the diagnosis. In this article, we present a representative case series of patients from our own practice who posed diagnostic dilemmas and propose a systematic approach for assessment for secondary causes of myelodysplasia.

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The perils of not digging deep enough—uncovering a rare cause of acquired anemia

Cited by 7 publications

References 19 publications

Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog

Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog

When Ring Sideroblasts on Bone Marrow Smears Are Inconsistent with the Diagnosis of Myelodysplastic Neoplasms

Be careful of the masquerades: differentiating secondary myelodysplasia from myelodysplastic syndromes in clinical practice

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