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Predicting the presence or absence of ringed sideroblasts in patients suspected of having a myelodysplastic syndrome and increased iron stores: a simple observation

Leukemia volume 15, pages 1793–1795 (2001)Cite this article

Refractory anemia with ringed sideroblasts (RARS) is one of the various myelodysplastic syndromes. It is characterized by 15% or more ringed sideroblasts in the bone marrow,1 increased bone marrow iron stores2 and less than 5% blasts in the bone marrow or less than 1% blasts in the peripheral blood.3 Ringed sideroblasts are erythroid precursors that have perinuclear aggregates of iron-laden mitochondria.4 Iron stores and ringed sideroblasts are demonstrated by staining the bone marrow smears with an acid potassium ferrocyanide solution (Prussian blue).5 Increased hemosiderin deposits are commonly seen in chronically transfused patients for various reasons including chemotherapy induced anemia.6 Myelodysplastic syndromes quite frequently have increased bone marrow iron stores.7 Increased iron deposits in patients with RARS have been described as finely granular or rarely coarsely granular.8 In hemosiderosis due to chronic transfusions the intracytoplasmic iron granules are large.2 We have observed that specific patterns of iron distribution are associated with the presence or absence of ringed sideroblasts ascertained with low power (4×–10×) light microscopy.

Prussian blue-stained bone marrow aspirate smears were reviewed from 58 adult and pediatric patients reported to have increased iron stores from 1993 to 2000 at Geisinger Medical Center in the Department of Laboratory Medicine. Twenty-seven patients were identified as having RARS. Thirty-one patients were chosen as controls on the basis of having increased bone marrow stores and a diagnosis other than RARS. The first bone marrow examination in patients with the diagnosis of RARS was used since the majority of these patients had multiple bone marrow examinations after the diagnosis was made and the iron staining pattern can change over time. The control group included various diagnoses such as acute myelogenous leukemia, acute lymphoblastic leukemia, Hodgkin's and non-Hodgkin's lymphoma, end-stage renal disease, reactive marrow, chronic lymphocytic leukemia, metastatic small cell carcinoma, immune thrombocytopenic purpura, essential thrombocytemia, monoclonal gammopathy of unknown significance and a normal marrow. Many of these patients had been chronically transfused and received chemotherapy for their respective malignancies. In cases where more than one smear was discovered for a single patient, the chronologically first smear was used for inclusion in the study. Laboratory computer records were reviewed to identify which patients had been multiply transfused. Geisinger Medical Center's Institution Research Review Board approved the study.

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  1. Department of Laboratory Medicine 01-31, Geisinger Medical Center, Danville, PA, USA

    RP Dorion, M Alomari & GC Wood

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  1. RP Dorion
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Dorion, R., Alomari, M. & Wood, G. Predicting the presence or absence of ringed sideroblasts in patients suspected of having a myelodysplastic syndrome and increased iron stores: a simple observation. Leukemia 15, 1793–1795 (2001). https://doi.org/10.1038/sj.leu.2402280

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