Circulating ringed sideroblasts in the course of the initial erythremic phase of erythroleukemia.

57-year-old man was admitted to our Institute with a two-week history fever up to 39°C, hepatomegaly and splenomegaly. Hematological findings were as follows: Hb 8.8 g/dL, platelet count 193310/L, WBC 54310/L with neutrophils 12%, lymphocytes 8%, blasts 80%, nucleated red blood cells 65/100 WBC. The immunological studies carried out by flow cytometry showed that circulating blasts were CD2, CD7, CD33, CD13, CD14, CD19 and CD10 negative. Examination of bone marrow aspirate smears revealed the presence of 70% erythroblasts, with a prevalence of proerythroblasts, early erythroblasts and blasts, a few of which contained cytoplasmic granules. The karyotype was normal. Erythroleukemia (EL) in the initial erythremic phase was diagnosed. The patient underwent induction chemotherapy but died two months later with a hematological picture of acute myeloblastic leukemia.