Recurrent sideroblastic anemia during pregnancy

Abstract

Sideroblastic anemia is a heterogeneous group of disorders typified by the presence of ring sideroblasts in the bone marrow and has congenital and acquired types. Sideroblastic anemia is a rare event in pregnancy. We report a case of a 32-year-old female patient, gravida 4 para 3, 27th weeks pregnant, who presented to the emergency department complaining of palpitation and generalized weakness for 2 weeks. She was found to have severe normochromic normocytic anemia, with hemoglobin of 4.2 g/dl, and low reticulocytes count of 13 × 10³/μl. She gave a history of recurrent anemia, which had only occurred during pregnancy. Her bone marrow aspirate showed many ring sideroblasts concluding the diagnosis of sideroblastic anemia (SA). Further investigation revealed a significantly low pyridoxine level (vitamin B6) of (8 nmol/L). The Hb level improved with vitamin B6 replacement, without any transfusion support.

Keywords: acquired sideroblastic anemia; congenital sideroblastic anemia; heme biosynthesis; iron chelation; ring sideroblasts; vitamin B6.

FIGURE 1

(A) Peripheral blood showing normochromic red cells with some hypochromic cells, (B) BM aspirate smears with different stages of granulocytic, vacuolated early precursors (arrowed) and late erythroblast with poorly developed cytoplasm (arrow head), (C) early precursor with cytoplasmic vacuolation, (D) late erythroid precursor with vacuolated poorly developed cytoplasm, (E) myelocyte with cytoplasmic vacuolation. Wright stain 1000×

FIGURE 2

Prussian blue stain on marrow aspirate smear. (A) Bone marrow particle with increased iron 400×, (B) ring sideroblasts with iron granules encircling the nucleus 1000×