Patnaik et al reported an algorithm for evaluating a patient with ring sideroblasts in the bone marrow. The authors are from the Mayo Clinic.
Patient selection: ring sideroblasts in the bone marrow
Initial evaluation:
(1) percent of erythroid cells showing dysplasia
(2) serum copper concentration
(3) mutations in SF3B1 (splicing factor 3 binding partner 1)
When to consider a myelodysplasia or a myeloid neoplasm - one of the following:
(1) presence of mutations in SF3B1
(2) > 10% erythroid cells showing dysplasia AND normal serum copper
Next level of evaluation:
(1) history of alcoholism
(2) lead toxicity
(3) zinc deficiency
(4) medications (INH, chloramphenicol, Linezolid)
If these findings are all negative, then consider a congenital sideroblastic anemia.
