Recurrent sideroblastic anemia during pregnancy

Sideroblastic anemia is a heterogeneous group of disorders typified by the presence of ring sideroblasts in the bone marrow and has congenital and acquired types. Sideroblastic anemia is a rare event in pregnancy. We report a case of a 32‐year‐old female patient, gravida 4 para 3, 27th weeks pregnant, who presented to the emergency department complaining of palpitation and generalized weakness for 2 weeks. She was found to have severe normochromic normocytic anemia, with hemoglobin of 4.2 g/dl, and low reticulocytes count of 13 × 103/μl. She gave a history of recurrent anemia, which had only occurred during pregnancy. Her bone marrow aspirate showed many ring sideroblasts concluding the diagnosis of sideroblastic anemia (SA). Further investigation revealed a significantly low pyridoxine level (vitamin B6) of (8 nmol/L). The Hb level improved with vitamin B6 replacement, without any transfusion support. Although Sideroblastic anemia is a rare type of anemia, it should be considered in cases of unexplained pregnancy‐relapsing anemia. Identification of possible revisable causes like pyridoxine deficiency is crucial to avoid both maternal and fetal adverse effects. Extensive workup including deep genetic testing might be required, guided by each case's clinical and histopathological findings..