Dimorphic anemia

Medical condition Sideroblastic anemia A ring sideroblast visualized by Sideroblastic anemia, or sideroachrestic anemia, is a form of ringed sideroblasts rather than healthy Sideroblasts ( per se does not define sideroblastic anemia. Only the finding of ring (or ringed) sideroblasts characterizes sideroblastic anemia. Ring sideroblasts are named so because iron-laden mitochondria form a ring around the nucleus. It is a subtype of Types [ ] The WHO International Working Group on Morphology of MDS (IWGM-MDS) defined three types of sideroblasts: [ citation needed] • Type 1 sideroblasts: fewer than 5 siderotic granules in the cytoplasm • Type 2 sideroblasts: 5 or more siderotic granules, but not in a perinuclear distribution • Type 3 or ring sideroblasts: 5 or more granules in a perinuclear position, surrounding the nucleus or encompassing at least one third of the nuclear circumference. Type 1 and type 2 are found in non-sideroblastic anemias. Type 3 is found only in sideroblastic anemia. [ citation needed] Symptoms and signs [ ] Symptoms of sideroblastic anemia include skin paleness, fatigue, dizziness, and enlarged Symptoms of sideroblastic anemia usually resemble the common symptoms of anemia. In addition to the symptoms listed above, patients with sideroblastic anemia may experience shortness of breath, heart palpitations, and headache. Some patients may have bronze-colored skin due to an overload of iron. Patients with syndromic hereditary sideroblastic anemia may experi...

A peripheral blood smear picture showing a dimorphic population of red blood cells: hypochromic, microcytic and normochromic, normocytic red cells. Dimorphissm is commonly seen in Sideroblastic Anemia cases. 50x oil immersion. From MLS Collection, University of Alberta, https://doi.org/10.7939/R3P844B3X A peripheral blood smear picture showing a dimorphic RBC population and tear cells in sideroblastic anemia. From MLS Collection, University of Alberta, https://doi.org/10.7939/R3CF9JN85 Cause(s):Development of sideroblastic anemia can be due to hereditary or acquired causes that lead to abnormal heme synthesis. 1,2 Hereditary: Sex-linked or autosomal recessive mutations Acquired: Idiopathic, MDS and other malignancies, drugs, lead toxicity Laboratory Features of Sideroblastic Anemia: 1-3 CBC: RBC: Decreased WBC: Variable PLT: Variable Hb: Decreased MCV, MCH, MCHC: Normal to Decreased (as they are averages of the RBC appearance) RDW: Increased RETIC: Decreased PBS: Dimorphic population (Normochromic/Normocytic alongside Hypochromic/Microcytic ) Tears Schistocytes Pappenheimer bodies Basophilic stippling BM: M:E Ratio: Decreased Erythroid hyperplasia (ineffective erythropoiesis) Ringed sideroblasts Macrophages have increased iron (Increased iron stores) Iron Studies: Serum Iron: Increased Ferritin: Increased Transferrin: Normal to Decreased Transferrin Saturation: Increased TIBC: Normal to Decreased Other Tests: Bilirubin: Increased Haptoglobin: Decreased LD: Increased Prussi...

Anisocytosis: Variation in RBC shape may include larger, smaller, teardrop-shape, acanthocytes (look like spurs), echinocytes (look like burrs), oval-shape, etc... as seen in the slide above. Dimorphic RBC populations include 2 variations of shape. Seen above: • Macrocytes (larger) • Polychromasia (blue-purple) • Acanthocytes (spurs) • Echinocytes (burrs) • Spherocytes • Microcytes (smaller) • Schistocytes (fragments) • Keratocytes (helmet cells) • Dacrocytes (teardrop) • Non-distinctive • Acanthocytes (Spike/Spur Cells): resemble the spurs on cowboy boots • Codocytes (Target Cells): resemble targets or "bull's eyes" • Dacrocytes (Teardrop Cells): resemble teardrops or raindrops • Degmacytes (Bite Cells): resemble cells that look as if they have a bite taken out of them • Drepanocytes (Sickle Cells): resemble sickles • Echinocytes (Burr Cells): resemble burrs • Elliptocytes/Ovalocytes: elliptical or oval-shaped cells • Keratocytes (Horn Cells): resemble horns • Microspherocytes: smaller • Macrocytes: larger • Pyropoikilocytes • Schistocytes (Helmet Cells): resemble Army helmets • Spherocytes (Microcytes): smaller • Stomatocytes (Mouth Cells): cells are swollen, so they look as if they are mouths Anisocytosis: Variation in RBC size/ diameter Anisocytosis means that a patient's erythrocytes are not of equal size. Red Cell Distribution Width (RDW) is a measurement of anisocytosis. If the RDW is >14.5%, this indicates a heterogenous population of RBC's, which means you will li...

Sideroblastic Anemia Typically, sideroblastic anemia develops insidiously in a middle-aged or elderly patient with normal or increased mean corpuscular volume (MCV) and a blood smear showing a population of hypochromic red cells. From: Hematology (Seventh Edition), 2018 Related terms: • Mitochondrial DNA • Iron Overload • Bone Marrow • Erythrocyte • Patient • Tissues • Chemotherapeutic Agent A May, in Blood and Bone Marrow Pathology (Second Edition), 2011 Differential diagnosis of primary sideroblastic anemia The diagnosis of sideroblastic anemia relies on the visual observation firstly of peripheral blood red cell hypochromia and then of ring sideroblasts in the marrow after staining for iron using a Perls' Prussian blue reaction ( Fig. 14.1F). Electron microscopy may be required to confirm the subcellular location of the iron in difficult or unusual cases ( Fig. 14.1G–I). For syndromic cases, histochemical staining of sections from biopsied muscle and measurement of respiratory complex activity by assay or by staining are often required and brain MRI is essential for some. There is considerable overlap of peripheral blood morphology and bone marrow features between different SA types. Sex, age of onset, severity of anemia, MCV, TEP, the ratio of zinc : free erythrocyte protoporphyrin (EPP) and presence of additional syndrome-associated pathology are therefore additional important differentiating features ( Table 14.1). Almost half inherited or congenital SA remain unexpl...