Sideroblastic Anemia Treated With Immunosuppressive Therapy

A case of apparently primary sideroblastic anemia, in an elderly woman, refractory to hematinic therapy and requiring many blood transfusions, was treated with azathioprine. Over a period of 6 mo, the hemoglobin level gradually rose to normal, no further transfusions have been required in the 30 mo since then, and the marrow picture shows a considerable decrease in the degree of mitochondrial iron overload. There was a simultaneous fall in the titer of HL-A cytotoxic antibodies. The possible role of immunologic factors in this sequence of events is discussed.