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.

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