Sideroblastic Anaemia: Is This a Malignancy?

Abstract

In participating in this discussion on ‘Sideroblastic Anaemia’, more particularly regarding its possible consideration as a malignancy, I must first point out that this term is but one amongst many. Thus, it is probable that the ‘primary refractory anaemia’ of Bomford and Rhoads (1941), the ‘refractory anaemia with hyperplastic marrow’ of Vilter, Jarrold, Will, Mueller, Friedman and Hawkins (1960), the ‘refractory sex‐linked hypochromic anaemia with high serum iron’ of Rundles and Falls (1946), the ‘chronic refractory anaemia with sideroblastic bone marrow’ of Björkman (1956) and the various disorders described by Heilmeyer, Keiderling, Bilger and Bernauer (1958) including ‘anaemia refractoria sidero‐blastica’, ‘anaemia refractoria sideroblastica hereditaria’ and ‘anaemia sideroachrestica’ are probably identical with what is being called sideroblastic anaemia here. What is more, there is relatively little to distinguish sideroblastic anaemia from what Dacie, Smith, White and Mollin (1959) have called ‘refractory normoblastic anaemia’. In America, the tendency has often been to dismiss all these terms and simply to use the quite vague one of ‘iron‐loading anaemia’, meaning a form of chronic hypochromic anaemia with high serum iron and large amounts of iron in the bone marrow. In our own nomenclature—and it appears that every worker in this field has his own term—we are inclined to group the ‘idiopathic’ non‐hereditary entities under the rubric of the Di Guglielmo syndrome. It should be noted that the term ‘sideroblastic anaemia’sensu stricto, indicates only the presence of sideroblasts in the bone marrow. However, nucleated red cells containing iron granules, at least in small number, are normal for the marrow and are increased under many circumstances, including most forms of haemolytic anaemia. To be sure, sideroblastic anaemia is used with the implication that the concentration of sideroblasts in the bone marrow is increased; thus ‘hypersideroblastic anaemia’ might be a better term. Some workers restrict the use of the term ‘sideroblastic anaemia’ to those cases of anaemia with high serum iron, a hyperplastic bone marrow with erythroblastic preponderance, and increased numbers of ‘ring form’ sideroblasts. In these cells, the iron granules are more or less concentrically situated about the nucleus. Whether the attempt to identify this disorder on the basis of a single morphological feature is a wise one is to be questioned.