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Case Reports
. 2025 Jul 1:2025:7046013.
doi: 10.1155/crh/7046013. eCollection 2025.

Successful Treatment of Anemia With Ringed Sideroblasts Induced by Antidepressants Through Vitamin B6 Supplementation and Discontinuation of Antidepressants

Sanshiro Nakao  1 , Chiaki Nakaseko  2 , Chikako Ohwada  2 , Keisuke Kirito  2   3 , Asuka Shibamiya  2 , Akane Tanaka  2 , Reiko Watanabe  2 , Naomi Shimizu  1
Affiliations
Case Reports

Successful Treatment of Anemia With Ringed Sideroblasts Induced by Antidepressants Through Vitamin B6 Supplementation and Discontinuation of Antidepressants

Sanshiro Nakao et al. Case Rep Hematol. .

Abstract

Vitamin B6 (VB6) is a vital coenzyme for δ-aminolevulinic acid synthase (ALAS) in heme biosynthesis. We report a 49-year-old male with severe microcytic anemia and ringed sideroblasts initially diagnosed as myelodysplastic syndrome (MDS). VB6 deficiency, attributed to long-term amoxapine use, was identified. His anemia improved significantly with VB6 supplementation and resolved completely after discontinuing amoxapine. This case highlights the need to consider VB6 deficiency in anemia with ringed sideroblasts.

Keywords: antidepressants; myelodysplastic syndrome; ringed sideroblasts; sideroblastic anemia; vitamin B6 deficiency.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Histological findings of the bone marrow. (a) May–Giemsa staining. (b) Iron staining.
Figure 2
Figure 2
Clinical course. Vitamin B6 supplementation dramatically improved his anemia, allowing him to become free from red blood cell transfusions. However, after reducing the vitamin B6 supplementation, microcytic anemia reappeared. His anemia resolved once again following the discontinuation of amoxapine. Vit B6: vitamin B6; PAL: pyridoxal.
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