A bone marrow assessment shows ringed sideroblasts comprising more than 15% of erythroid precursors. What is the presumptive diagnosis?

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Multiple Choice

A bone marrow assessment shows ringed sideroblasts comprising more than 15% of erythroid precursors. What is the presumptive diagnosis?

Ringed sideroblasts are erythroid precursors in which iron-loaded mitochondria encircle the nucleus due to impaired heme synthesis. In myelodysplastic syndromes, a high proportion of ring sideroblasts defines a distinct subtype: when more than 15% of erythroid precursors show ring sideroblasts, the presumptive diagnosis is Refractory Anemia with Ring Sideroblasts. This condition features erythroid dysplasia with prominent ring sideroblasts but without a significant increase in blasts, so it is not classified as RAEB or AML, which require higher blast counts. Other disease patterns—like chronic myelomonocytic leukemia, which centers on monocytic proliferation, or AML variants that require many blasts—do not fit the erythroid-dominant ring sideroblast finding. Therefore, the presence of >15% ring sideroblasts points to RA with ring sideroblasts.

Ringed sideroblasts are erythroid precursors in which iron-loaded mitochondria encircle the nucleus due to impaired heme synthesis. In myelodysplastic syndromes, a high proportion of ring sideroblasts defines a distinct subtype: when more than 15% of erythroid precursors show ring sideroblasts, the presumptive diagnosis is Refractory Anemia with Ring Sideroblasts. This condition features erythroid dysplasia with prominent ring sideroblasts but without a significant increase in blasts, so it is not classified as RAEB or AML, which require higher blast counts. Other disease patterns—like chronic myelomonocytic leukemia, which centers on monocytic proliferation, or AML variants that require many blasts—do not fit the erythroid-dominant ring sideroblast finding. Therefore, the presence of >15% ring sideroblasts points to RA with ring sideroblasts.

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