Abstract
A 64-year-old female was admitted to the Juntendo University Hospital with complaints of fever, vomiting, and right hypochondralgia in Sept. 1976.
Physical examination revealed severe pallor, tenderness, and resistence over the right hypochondrium.
Hematological examination on admission showed hemoglobin 5.3 g/dl, red blood cells 187×104/mm3, white blood cells 9,000/mm3 with a small number of the immature granulocytes and the partial hypochromia of the red cells.
Bone marrow aspirate revealed an erythroid hyperplasia with numorous ringed sideroblasts but no megaloblastic change. PAS stain was negative.
A chromosomal analysis showed no abnormality with negative Ph1 chromosome.
E. coli was cultured from her blood and bile, and a diagnosis of primary acquired sideroblastic anemia complicated with sepsis was made.
The sepsis was successfully treated with antibiotics and the external biliary drainage. She was placed on folate and pyridoxine with no improvement of anemia.
On Oct. 1977, a small number of myeloblasts and erythroblasts appeared in the peripheral blood. The bone marrow specimen obtained in Nov. 1977 showed an increase in atypical myeloblasts and a megaloblastic change in erythroid cells.
