Refractory Anemia With Ringed Sideroblasts

The morphologic features of RARS are similar to those of RA, except that there are more than 15 percent ringed sideroblasts in the bone marrow. Macrocytosis and dysmorphic red cells are present in the peripheral blood (Plate 14-26). In pure RARS DysG and DysM are absent or reveal only occasional individual cell dysplasia (less than 10 percent). These cases are character ized by very low risk of progression to AML. In the dysplastic form of sideroblastic anemia, iron overload is associated with marrow dysplasia; those cases are associated with leukemic progression and shorter overall survival.

In the recent WHO proposal of MDS, RA and RARS are defined as disorders involving only the erythroid line11 as defined above.

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