Sideroblastic anemia Quiz: Ace Your Exams

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A 6-year-old boy is brought to the physician by his parent, who states the patient has been lethargic for the past several weeks. The patient is in the 30th percentile for height and weight and has no significant past medical history. He has no abnormal bleeding, recent infections, or loss of sensation in the limbs. Temperature is 37.0°C (98.6°F), pulse is 96/min, respirations are 17/min, and blood pressure is 114/68 mmHg. Physical examination shows conjunctival pallor. Laboratory studies are as follows:  

 Laboratory Value  Result  Reference Range 
 Hemoglobin  9.8 g/dL  13.5-17.5 g/dL 
 Mean corpuscular volume  78 fL  80-100 fL 
 Reticulocyte count  0.5%  0.5-1.5% 
 Serum iron  45 μg/dL  50-170 μg/dL 
 Ferritin  180 ng/mL  15-200 ng/mL 
 Lead  1 μg/dL  <5 μg/dL 
   
Bone marrow aspirate with Prussian blue stain reveals ringed, immature red blood cells, as demonstrated below:
A microscopy image shows various blood cells on a light background. Round red blood cells are visible, along with larger, irregularly shaped cells w/ bluish staining.
Image reproduced from Wikimedia Commons


Which of the following is the most likely etiology of this patient’s clinical condition?  

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