To understand the causes of sideroblastic anaemia, the pathway of haem synthesis is described in Figure 1.
Primary acquired sideroblastic anaemia, which involves abnormal haematopoiesis, is idiopathic, as it is not clear what the cause of defective haem synthesis is in the abnormal erythroid clone (3) This type of sideroblastic anaemia is the one most commonly seen in the haematology laboratory, as it is part of the myelodysplastic syndromes--a series of clonal haematopoietic stem cell diseases.
One of the most common causes of secondary acquired sideroblastic anaemia is chronic ethanol consumption, with a ringed sideroblast abnormality occurring in 25-30% of anaemic alcoholic patients (1,4,5).
The case of patient B has presented an example of secondary acquired sideroblastic anaemia caused by chronic alcoholism and associated folate deficiency.
The correlation between alcoholism, folate deficiency and secondary acquired sideroblastic anaemia is shown in Figure 3.