Marwa Mostafa: The Paradox of Sideroblastic Anemia
Marwa Mostafa, Clinical Pathologist at Al-Esraa Medical Center, shared a post on LinkedIn:
“Sideroblastic Anemia
Microcytosis plus high iron? Think beyond iron deficiency.
Sideroblastic anemia is a fascinating example of how anemia can result not from a lack of iron, but from a problem using it.
In this infographic, we explore:
What happens?
Iron is available — often increased — but defective heme synthesis prevents its proper incorporation into hemoglobin.
The laboratory pattern
- low Hb
- low MCV (often)
- high Serum iron
- high Ferritin
- high TSAT
- low/normal TIBC
The key bone marrow finding
Ring sideroblasts — erythroid precursors with iron-laden mitochondria surrounding the nucleus.
Common causes
MDS, alcohol, vitamin B6 deficiency, lead toxicity, certain medications, and congenital forms.
Clinical Pearl:
- Iron deficiency: not enough iron.
- Sideroblastic anemia: iron is present, but heme synthesis is defective.
The iron is there — the problem is using it.”
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