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Primary sideroblastic anemia masked by bleeding

E R Popescu, M E Fitzgerald, O J Martelo

    Folia Haematologica (Leipzig, Germany : 1928)
    |January 1, 1978
    PubMed
    Summary
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    Iron deficiency anemia can mask underlying sideroblastic anemia, indicated by circulating siderocytes. Iron replenishment revealed the masked sideroblastic process, highlighting a diagnostic challenge in hematology.

    Area of Science:

    • Hematology
    • Iron Metabolism
    • Anemia Pathophysiology

    Background:

    • Iron deficiency anemia (IDA) is common, characterized by depleted iron stores.
    • Siderocytes, or erythrocytes containing iron granules, are typically associated with sideroblastic anemia (SA).
    • The presence of siderocytes in IDA is unusual and warrants further investigation.

    Observation:

    • A patient presented with clinical features of IDA but unexpectedly showed circulating siderocytes.
    • Bone marrow examination revealed no hemosiderin or ringed sideroblasts, ruling out typical SA.
    • Electron microscopy showed cytoplasmic ferritin but no mitochondrial iron loading in normoblasts.

    Findings:

    • The initial presentation mimicked IDA, but the presence of siderocytes suggested a concurrent or masked condition.

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  • Following iron repletion, the patient developed overt sideroblastic anemia.
  • These findings indicate that siderocytes in IDA can represent a masked sideroblastic process.

    • Implications:

    • Increased siderocyte percentage in IDA may indicate an underlying, masked sideroblastic anemia.
    • This challenges conventional diagnostic approaches for anemia.
    • Recognizing this presentation is crucial for accurate diagnosis and appropriate treatment of complex anemia cases.