2013 Volume 16 Issue 1 Pages 25-30
A 69-year-old man who had been treated for chronic obstructive lung disease presented with microcytic and hypochromic anemia. His hemoglobin level was 7.6 g/dL, mean corpuscular volume 70 fL, mean hemoglobin concentration 21.1 pg, and mean corpuscular hemoglobin concentration 30.3%. Iron overload was evident by increased serum iron of 233 μg/dL, reduced total iron binding capacity of 265 μg/dL, increased transferrin saturation of 87.9%, and increased serum ferritin of 552 ng/mL. The bone marrow showed 60 to 70% cellularity including siderocytes (7% erythrocytes) and ring sideroblasts (45% erythroblasts) containing iron deposits, which fulfilled the diagnostic criteria of sideroblastic anemia (SA). He had reportedly drunk a 4-liter bottle of shochu every few days for over 5 years; however, he now abstained from alcohol, as he was no longer able to drink owing to respiratory distress. Although anemia initially progressed so that a blood transfusion was required, the hemoglobin level steadily increased during the follow-up period; 8 months after the initial presentation, the hemoglobin value was 14.6 g/dL with normal erythrocyte indices. We first considered that the patient had a subtype of myelodysplastic syndrome (MDS), in which the presence of ring sideroblasts was predominant. The clinical course, however, indicated that the disease was acquired and reversible SA associated with alcoholism. This case report reminds us that MDS with ring sideroblasts must be carefully differentiated from non-neoplastic conditions.
