Peripheral Blood and Bone Marrow Findings in Chronic Alcoholics with Special Reference to Acquired Sideroblastic Anemia


Anemia associated with alcoholism has numerous causes, most common being megaloblastic anemia and acquired sideroblastic anemia (SA). The bone marrow aspirate (BMA) and bone marrow iron (BMIr) findings and their correlation with peripheral blood smear (PBS) have not been extensively described in literature. We aim to study the spectrum of hematological abnormalities in chronic alcoholics. Complete blood count (CBC), PBS, BMA and BMIr of 71 chronic alcoholics were studied retrospectively over a period of 3 years. The slides were reviewed by 2 pathologists. The clinical history, CBC, PBS, BMA and BMIr findings were recorded. Out of 71 patients, 68 (95.77%) had anaemia. Red cell morphology varied from normocytic-normochromic, microcytic-hypochromic, macrocytic, to dimorphic anaemia. Principal findings seen on BMA were erythroid hyperplasia and megaloblastic maturation. BMIr was available in 41 patients; iron stores were decreased in 2 (4.88%), normal in 14 (34.15%), increased in 25 (60.97%). Seven (17.07%) cases showed presence of ring sideroblasts. Chronic alcoholics show a variety of abnormalities in BMA, which closely mimic many haematological disorders. A history of alcoholism should always be taken in these circumstances. SA should be ruled out in all chronic alcoholics with anaemia not responding to vitamin B12/folic acid, even with macrocytic picture on PBS.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2



Peripheral blood smear


Sideroblastic anemia


Bone marrow aspiration


Bone marrow iron




Mean corpuscular volume


Mean corpuscular hemoglobin


Mean corpuscular hemoglobin concentration


Myelodysplastic syndrome


Complete blood count


  1. 1.

    Eichner ER, Hillman RS (1971) The evolution of anemia in alcoholic patients. Am J Med 50(2):218–232

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Lindenbaum J, Roman MJ (1980) Nutritional anemia in alcoholism. Am J Clin Nutr 33(12):2727–2735

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Mason DY, Emerson PM (1973) Primary acquired sideroblastic anemia: response to treatment with pyridoxal-5-phosphate. Br Med J 1(5850):389–390

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4. Accessed 22 Aug 2019

  5. 5.

    World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO/NMH/NHD/MNM/11.1. Accessed 22 Aug 2019

  6. 6.

    Erkurt MA, Kaya E, Berber I, Koroglu M, Kuku I (2012) Thrombocytopenia in adults: review article. J Hematol 1(2–3):44–53

    CAS  Google Scholar 

  7. 7.

    Narang NC, Kotru M, Rao K, Sikka M (2016) Megaloblastic anemia with ring sideroblast is not always myelodysplastic syndrome. Turk J Haematol 33(4):358–359

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Cowan DH, John DH (1971) Thrombocytopenia of severe alcoholism. Ann Intern Med 74(1):37–43

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Latvala J, Parkkila S, Niemelä O (2004) Excess alcohol consumption is common in patients with cytopenia: studies in blood and bone marrow cells. Alcohol Clin Exp Res 28(4):619–624

    PubMed  Article  Google Scholar 

  10. 10.

    Alcindor T, Bridges KR (2002) Sideroblastic anemias. Br J Haematol 116:733–743

    PubMed  Article  Google Scholar 

  11. 11.

    Cazzola M, Invernizzi R (2011) Ring sideroblasts and sideroblastic anemias. Haematologica 96(6):789–792

    CAS  PubMed  PubMed Central  Article  Google Scholar 

Download references



Author information



Corresponding author

Correspondence to Mrinalini Kotru.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mangla, G., Garg, N., Bansal, D. et al. Peripheral Blood and Bone Marrow Findings in Chronic Alcoholics with Special Reference to Acquired Sideroblastic Anemia. Indian J Hematol Blood Transfus 36, 559–564 (2020).

Download citation


  • Chronic alcoholics
  • Ring sideroblasts
  • Peripheral blood smear
  • Bone marrow aspirate
  • Acquired sideroblastic anemia
  • Bone marrow iron