The Iron-man: A case-report

The most common cause of microcytic anemia is iron deficiency. We report a 29 year old man with history of dyspnea, fatigue and severe microcytic anemia despite iron therapy for 3 years. Blood transfusions elevated the hemoglobin levels temporarily, but iv iron did not. Bone marrow showed sideroblastic anemia. The anemia resolved with pyridoxine treatment but severe iron overload necessitated multiple phlebotomies. Today the patient is asymptomatic on pyridoxine with a normal hemoglobin level.

Figure 1. Bone marrow smear (Prussian blue stain). Iron is blue. The arrowhead points to ring-sideroblast. The iron deposition in the erythroblast´s mitochondria is in perinuclear distribution