Chronic refractory anemia with sideroblastic bone marrow; a study of four cases.

By SVEN E1t1K BJ#{246}RKMAN T liE I HESENCE of free iron in nom’moblasts ‘as fil’st. (IeIllolistI’ate(l l)y ( rflneherg in 1942.l Il-i sti.tdies of the anemia of the flex-tailed mouse lid’ found that 1)0th the i’ed (‘dl precursors and the ripe ei’ythroo’ytes oontaiiied grallulat’ niatem’ial stainable with the Prussian blue reao’tion. Lat.em’2 su(’h sideroblasts, tis they were (ailed! by the original ilivest.igatol’, were fouiid to o(’(uI’ also ill huliian bone marrow. The iron which stailis in this niannel’ does not 1)elOlig to the hemoglobili 1)111. is l)elieved to) be free iron which has not. yet entered the heme.2’ Its pI’eselle (‘all he (Onsidel’ed as a normal finding and then heimig a normal transition stage ill the intracellular iron liiet.aholislii. Au increase of this iron can howevel’ he i’egarded as a sign of a shift in the ratio henioglohiii iron : free iron in favor of the latter.5 This has been looked upon as a sign of a defective hemoglobin synthesis.1’6 Fle(’ently it has been shown that when I’a(Iioiron is incorporated into mlorniol)lasts in tissue culture the aut.oradiographic pi(’tUI’es heoonie \‘eI’y siluilat’ to siderol)lasts.7 The purpose of this ooiiiniunio’at.ioii is to report foul’ cases in which gI’eat. aniounts of free ii’oii in the nom’inoblasts represented the outstanding fiuiding ill the nial’row smnears. All oases oo(url’ed iii old males having (hi’olii( i’efl’a(’t.OI’y ItI1(’Illia. In t.hm’ee of the oases the etiology of the aneiiiia was unknown although hypem’plastic I )OI ie inai’i’ow suggested heniolyt ic ancliiia . I Ii the fourth CaSd’ the allelnia ol)viously was m’elat.ed to other diseases. It. is believed that these cases belong to the same eIitit.y within the group of ‘‘aplastic’’ anemias. The comnio i (lellonhillatol’ is thought. to 1)e that of a defective hemoglobin syllthesis.