Careful examination of the peripheral blood smear can help to identify a patient with sideroblastic anemia.
Clues to the presence of a sideroblastic anemia:
(1) dimorphic red cell population (microcytic/hypochromic and normocytic/normochromic; normocytic and macrocytic)
(2) moderate poikilocytosis with hypochromic teardrop forms
(3) basophilic stippling (usually coarse)
(4) Pappenheimer bodies
(5) lower than expected reticulocyte count
(6) MCHC normal to low but not very low
(7) abnormal myeloid series and platelets suggesting myelodysplasia
Sideroblastic anemia should also be considered when there is a microcytic/hypochromic anemia AND iron deficiency, thalassemia and anemia of chronic disease are unlikely.
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