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

Abstract

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.

Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications

“…In addition to the different rate of RBC transfusions between the various hematologic and other categories of iron-loaded patients, there are also many patient categories needing transfusions because of different causes of anemia, such as sideroblastic anemia, where iron is deposited in the mitochondria of sideroblasts [ 44 , 45 , 46 ]. In all RBC, transfusional iron-loaded categories and non-transfusional iron-loaded categories such as idiopathic hemochromatosis patients where venesection is contraindicated, iron chelation therapy needs to be introduced in order to reduce or eliminate the iron toxicity ( Table 1 ) [ 34 , 47 , 48 ].…”