- Systemic lupus erythematosus (SLE).
- Inflammatory conditions such as rheumatoid arthritis.
- Chronic infections.
- Drug toxicity.
- Chronic alcoholism.
- Hemolytic anaemia.
- Malabsorption syndromes.
- Lead poisoning.
- Diagnosis is made from bone marrow examination demonstrating the presence of ring sideroblasts with a generalized increase in iron stores.
- A full blood count (FBC) usually shows a moderate anemia.
- The mean corpuscular volume (MCV) is normal or increased, but can be low.
- High serum iron and transferring saturation also occur.
- The blood film shows a dimorphic population of both normal and hypochromic red blood cells.
- Treatment is mainly supportive.
- Red cell transfusion is given for symptomatic anemia.
- Iron chelation with deferoxamine should be considered after 20-25 units of red cells have been received.
- Avoid alcohol and vitamin C as these increase iron absorption.
- The use of erythropoietin plus or minus granulocyte colony-stimulating factor has been demonstrated to reduce the need for red cell transfusion in some patients with myelodysplastic syndrome but the studies were small.
- Patients with hereditary sideroblastic anemia may respond to pyridoxine.
- Cyclosporin A has been shown to give a response rate (i.e. alteration of disease progression or remission) of 62.5% in patients with myelodysplastic syndromes including sideroblastic anaemia.
- New therapies are emerging, approved by the United States FDA in 2004. There are two DNA methyltransferase inhibitors (azacitidine and decitabine) and an immunomodulatory agent (lenalidomide).
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