Sideroblastic anemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nazia Fuad M.D.

Differential Diagnosis

Sideroblastic anemia must be differentiated from other causes of microcytic hypochromic anemia: iron deficiency anemia, thalassemia, anemia of chronic disease, lead poisoning, and blood loss.

• Tissue iron overload from sideroblastic anemia may act similar to hereditary hemochromatosis with liver cirrhosis, diabetes, congestive heart failure, and cardiac arrhythmias.

• ALA Dehydratase Deficiency Porphyria
• Acute Myeloid Leukemia (AML)
• Congenital Erythropoietic Porphyria
• Hereditary Coproporphyria
• Iron Deficiency Anemia
• Myelodysplastic Syndrome
• Secondary Thrombocytosis

Diseases		Clinical manifestations						Para-clinical findings								Gold standard
		Symptoms			Physical examination
								Lab Findings
		Pallor	Weakness	Jaundice	Hepatomegaly	Splenomegaly	Growth retardation	Peripheral blood smear	Serum iron	Serum TIBC			Serum ferritin g/L	Iron in erythroblasts	Iron stores in bone marrow
	Sideroblastic anemia	+	+					variable	Normal -high	Normal			50-300	present in ring form	present
Microcytic hypochromic anemia	Iron deficiency anemia	+		+				microcytic/ hypochromic	<30	> 360			<15	absent	absent
	Thalasemia		jaundice	+	Hpatomegaly	Splenomegaly	Growth retardation	micro/hypo with targeting	Normal -high	Normal			50-300	present	present
	Anemia of chronic disease							Normal	Low	<300			30-200	absent	present
	Lead poisoning
	Blood loss
Tissue iron overload