Globin chain synthesis ratios in sideroblastic anaemia

S ummary . Globin synthesis ratios were measured on reticulocytes from nine patients with primary acquired sideroblastic anaemia (SA), four patients with hereditary or congenital SA, two patients with secondary acquired SA and three patients with iron deficiency (ID). Ten of the samples from patients with SA and all the samples from patients with ID had normal ratios. Samples from three patients had significantly abnormal ratios, one from a patient with SA and acquired Hb H disease (α/β 0–26), one from a patient with secondary acquired SA (α/β 0–88), and one from a patient who went on to develop acute myeloblasts leukaemia (α/β 1–36). Globin synthesis was stimulated by 100 μ haem similarly in normal, SA and ID reticulocytes. Any limitation of globin synthesis in SA and ID is therefore not easily reversible by adding haem. Inhibition of haem synthesis in nonsideroblastic reticulocytes using 4 mM isonicotinic acid hydrazide for 1 h incubation affected neither total globin synthesis nor the α/β ratio. These results contradict the view that decreased haem synthesis decreases globin chain synthesis and decreases the α/β globin chain synthesis ratios in human reticulocytes. Previously reported findings that haem could reverse globin chain synthesis inhibition in SA were good evidence for a primary deficiency of haem synthesis in the erythroblasts of these patients. Our inability to substantiate these findings emphasizes the need for a re‐evaluation of the aetiology of sideroblastic anaemia.