Main clinical features
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early onset with variable pyridoxine responsiveness, also late onset with constant pyridoxine responsiveness
hypochromic microcytic anemia with 2 discrete populations of red blood cells, one microcytic and the other normocytic, marrow ringed sideroblasts, particularly prominent in the late erythroid precursors, and systemic iron overload secondary to chronic ineffective erythropoiesis
severity of the disorder (neonatal to late onset) depends primarily on the amount of residual ALAS2 mitochondrial enzyme activity (PMID: 22740690)) |