International Journal of Laboratory Hematology The Ofﬁcial journal of the International Society for Laboratory Hematology ORIGINAL ARTICLE INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY Sideroblastic changes of the bone marrow can be predicted by the erythrogram of peripheral blood A. ROVO´ , G. STU¨ SSI, S. MEYER-MONARD, G. FAVRE, D. TSAKIRIS, D. HEIM, J. HALTER, C. ARBER, J. PASSWEG, A. GRATWOHL, A. TICHELLI Hematology, University Hospital of Basel, Basel, Switzerland Correspondence: Alicia Rovo´, Diagnostic Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland. Tel.: +41 61 328 7362; Fax: +41 61 265 4450; E-mail: ARovo@uhbs.ch doi:10.1111/j.1751-553X.2009.01185.x Received 24 February 2009; accepted for publication 10 July 2009 Keywords Ring sideroblasts, sideroblastic anemia, myeloid neoplasms, myelodysplastic syndromes, scattergram, erythrogram S U M M A R Y The diagnosis of sideroblastic anemia is based on bone marrow aspiration, and the detection of ring sideroblasts (RS) in iron staining. The ﬁnding of laboratory parameters to approach this diagnosis still remains a great challenge. In this study, we analyzed the value of a speciﬁc erythrogram pattern from peripheral blood, produced by the ADVIA 120 cell counter, to predict sideroblastic changes in the bone marrow. In a two step-design study, we first showed that 32/38 consecutive patients reporting 15% RS had such a pattern in the erythrogram. In the second step, we prospectively identified over a period of 32 months 21 patients with this typical erythrogram; 20/21 had 15% RS in the bone marrow. Hence, by this validation, we confirm that the erythrogram is highly predictive of RS in the bone marrow. The interpretation of the erythrogram should become daily practice in hematology to improve the efficacy to detect sideroblastic changes. I N T R O D U C T I O N The presence of ring sideroblasts (RS) in the bone marrow aspiration is the hallmark for hereditary and acquired sideroblastic anemia. Sideroblasts are visible with Perl’s Prussian blue staining under microscopic examination of bone marrow. In adult patients, RS are highly suggestive of a myelodysplastic syndrome (MDS) or another type of myeloid neoplasm with RS, Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://www3.interscience. wiley.com/authorresources/onlineopen.html when other causes have been ruled out. In acquired sideroblastic disorders, anemia is usually normo- or macrocytic with a variable population of hypochromic red blood cells (RBCs) on the blood smear, and the occasional presence of circulating erythroblasts. However, none of these changes in peripheral blood is distinctive enough to predict the diagnosis of siderob- lastic anemia. New generation hematology systems supply essen- tial information on blood cells, complementing micro- scopic cell examination. The RBC scatter plots, generated by the automated ADVIA 120 hematology analyzers (Bayer Diagnostics, Tarrytown, NY, USA), 2009 The Authors Journal compilation 2009 Blackwell Publishing Ltd, Int. Jnl. Lab. Hem. 2010, 32, 329–335 329