Table 1.

Differential diagnosis of bone marrow ring sideroblasts

Clonal – Myeloid Neoplasms	Non Clonal Causes
1. Myelodysplastic syndrome (MDS) MDS with ring sideroblasts and single lineage dysplasia (MDS-RS SLD) MDS with ring sideroblasts and multilineage dysplasia (MDS-RS-MLD) MDS with excess blasts and ring sideroblasts MDS-U with ring sideroblasts	1. Hereditary sideroblastic anemia X- linked sideroblastic anemia- ALAS2 mutations SLC25A38 related sideroblastic anemia Glutaredoxin 5 (GLRX5) related sideroblastic anemia Congenital sideroblastic anemia without identified molecular defects Sideroblastic anemia as a component of genetic syndromes X-linked sideroblastic anemia with ataxia- ABCB7 mutations Kearns Sayre syndrome Myopathy, lactic acidosis, and sideroblastic anemia Sideroblastic anemia, B cell immunodeficiency, periodic fevers, and developmental delay Pearson marrow-pancreas syndrome Thiamine-responsive megaloblastic anemia syndrome Congenital sideroblastic anemia due to NDUFB11 mutations.
2. Myeloproliferative neoplasms (MPN) Essential Thrombocythemia with ring sideroblasts Primary myelofibrosis with ring sideroblasts	2. Alcoholism
3. MDS/MPN overlap syndromes MDS/MPN with ringed sideroblasts and thrombocytosis (MDS/MPN-RS-T) Chronic myelomonocytic anemia with ring sideroblasts Unclassified MDS/MPN with ring sideroblasts	4. Drug induced sideroblastic anemia INH Chloramphenicol Linezolid Penicillamine
	5. Copper deficiency
	6. Lead poisoning
	7. Zinc toxicity