The sideroblastic anemias feature the presence of abnormal sideroblasts in the bone marrow.
The sideroblasts of sideroblastic anemia are:
(1) normoblasts
(2) have multiple large siderotic granules (on an iron stain)
(3) perinuclear location
(4) completely or partially around the nucleus
On electron microscopy the granules show iron deposits located between cristae of mitochondria. Normally iron is found in the cytoplasm and not in mitochondria.
Ring sideroblasts may be missed (false negative) if the patient is iron deficient.
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