A diagnostic pitfall in iron-refractory microcytic hypochromic anemia with acquired ring sideroblasts initially treated as iron deficiency anemia—a case report

Microcytic hypochromic anemia is commonly presumed to represent iron deficiency anemia (IDA) at initial presentation. However, failure to respond to iron supplementation and iron indices inconsistent with IDA should prompt early diagnostic reassessment. We report a 67-year-old woman with severe microcytic hypochromic anemia after ineffective iron therapy. Iron studies indicated iron loading with impaired iron utilization rather than iron deficiency. Bone marrow Perls staining revealed ring sider