A 62-year-old man with long-standing alcohol use has Hb 10 g/dL, MCV 76 fL, and a peripheral smear showing occasional hypochromic cells. Bone marrow iron stain with Prussian blue reveals normoblasts with a perinuclear collar of iron granules. What is the diagnosis?

• A Sideroblastic anemia ✓
• B Anemia of chronic inflammation
• C Iron deficiency anemia
• D Thalassemia trait

Explanation

Ringed sideroblasts are erythroid precursors with iron-laden mitochondria encircling the nucleus, visible on Prussian blue stain. They indicate defective heme incorporation into protoporphyrin, seen in myelodysplastic syndromes, alcohol use, isoniazid therapy, and copper deficiency. Iron deficiency would show absent marrow stores, anemia of chronic disease shows increased macrophage but not erythroid iron, and thalassemia trait does not produce ringed sideroblasts.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.