Sideroblastic Anemia!
Sideroblast = erythroblast (developing RBC) with iron-loaded mitochondria appear perinuclear granules when stained with Prussian blue
Pathologic = ring sideroblast = iron-laden mitochondria form a complete or partial ring around the nucleus
Anemia bone marrow with ring sideroblast DDx
Divide by acquired vs neopalstic vs inherited
Acquired:
Drugs/toxin = EtOH, Pb
⬇️nutrtient = Cu, B6
Neoplastic:
MDS = RARS (SF3B1 mut)
MDS/MPN overlap = RARS-T (thrombocytosis)
Inherited:
XLSA = ALAS2 mutation
Pearson syndrome
Thiamine response megaloblastic anemia