Refractory Sideroblastic Anemia (Chronic Erythremic Myelosis)

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Abstract
The bone marrows of two patients wth refractory sideroblastic anemia (chronic erythremic myelosis) were studied by light and electron microscopy. The two marrows were characterized by erythroid hyperplasia with megaloblastoid nuclear changes, abnormally-shaped nuclei, numerous sideroblasts, PAS-positivity in the cytoplasm of some erythroid precursors, and a shift toward immaturity of the developing granulocytes. Ultrastructurally, ferritin particles were present in mitochondria of early normoblasts, and large masses of iron were present in mitochondria of intermediate and late normoblasts and reticulocytes. Iron was also seen in membrane-bound structures, and ferritin particles were scattered throughout the cytoplasm of erythroid precursors. There was evidence of continued uptake of ferritin by the iron-overloaded, developing erythrocytes. Ferritin particles were present, with an electron-dense material between and on the surface of adjacent erythroid precursors, and within micropinocytotic vesicles or erythrocytes. Evidence of ineffective erythropoiesis in the form of erythrophagocytosis of developing erythrocytes was a prominent feature of this disorder.

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