Bone marrow aspirate: ring sideroblasts Ringed sideroblasts are seen in the bone marrow. On the peripheral blood smear can be found erythrocytes with basophilic stippling (cytoplasmic granules of RNA precipitates) and Pappenheimer bodies (cytoplasmic granules of iron). The anemia is moderate to severe and dimorphic. Microscopic viewing of the red blood cells will reveal marked unequal cell size and abnormal cell shape. Basophilic stippling is marked and target cells are common. The mean cell volume is commonly decreased (i.e., a microcytic anemia), but it may also be normal or even high. The RDW is increased with the red blood cell histogram shifted to the left. Leukocytes and platelets are normal. Bone marrow shows erythroid hyperplasia with a maturation arrest.In excess of 40% of the developing erythrocytes are ringed sideroblasts. Serum iron, percentage saturation and ferritin are increased. The total iron-binding capacity of the cells is normal to decreased. Stainable marrow hemosiderin is increased. Classification<unk>  is typically divided into subtypes based on its cause. * Hereditary or congenital<unk>  may be X-linked or autosomal. OMIM Name Gene X-linked<unk>  (XLSA) ALAS2<unk>  with spinocerebellar ataxia (ASAT) ABCB7 pyridoxine-refractory autosomal recessive<unk>  SLC25A38 pyridoxine-responsive<unk>  (vitamin B6 deficiency; pyridoxal phosphate required for heme synthesis) GLRX5 has also been implicated. * Acquired, or secondary,<unk>  develops after birth and is divided according to its cause. Laboratory findings * Serum Iron: high * increased ferritin levels * decreased total iron-binding capacity * high transferrin saturation * Hematocrit of about 20-30% * The mean corpuscular volume or MCV is usually normal or low for congenital causes of<unk>  but normal or high for acquired forms. * With lead poisoning, see coarse basophilic stippling of red blood cells on peripheral blood smear * Specific test: Prussian blue stain of RBC in marrow shows ringed sideroblasts. Prussian blue staining involves a non-enzymatic reaction of ferrous iron with ferrocyanide forming ferric-ferrocyanide, which is blue in color. A counterstain may be used to provide better visualization.
Sideroblastic anemia
Refractory anemia with ring sideroblasts
Myelophthisic anemia
Myomatous erythrocytosis syndrome
Refractory anemia with excess of blasts
Congenital hypoplastic anemia
Hereditary spherocytosis
Thiamine responsive megaloblastic anemia syndrome