Myelodysplastic syndrome with ring sideroblasts and single lineage dysplasia

ICD-O-2 Morphology

ICD-O-3 Morphology

9982/3: Myelodysplastic syndrome with ring sideroblasts and single lineage dysplasia
Effective 2001 and later


for cases diagnosed 2001 and later

Primary Site(s)

Primary site must be bone marrow (C421)

Abstractor Notes

People with RA with ring sideroblasts are similar to those with refractory anemia except that many of the red blood cells in the bone marrow contain characteristic ring-shaped iron deposits which are called ring sideroblasts.

The principle sites of involvement are the peripheral blood and bone marrow.

For MDS diseases (9980, 9982, 9983, 9985, 9986, 9989, 9991, 9992,9993), abstracting each of the subtypes would result in over-counting of the diseases.
1. Code only the first subtype that is diagnosed.
2. Do not change the histology code or create a new abstract for any subsequent specific MDS subtypes.

Hematologic Transplant and/or Endocrine Procedures treatments include bone marrow and stem cell transplants.

Diagnostic Confirmation

This is a histology for which the Definitive Diagnostic Method does not include Genetics Data or Immunophenotyping, thus Diagnostic Confirmation should never be 3. If genetics and/or immunophenotyping are available, re-review to see if a more specific neoplasm can be coded.


Not Applicable

Module Rule


Alternate Names

Acquired idiopathic sideroblastic anemia
Myelodysplastic syndrome with ring sideroblasts, NOS
Myelodysplastic/myeloproliferative neoplasm with ring sideroblasts and thrombocytosis
Refractory anemia with hemochromatosis
Refractory anemia with ring sideroblasts associated with marked thrombocytosis
Refractory anemia with ringed sideroblasts
Refractory anemia with ring sideroblasts, NOS
Refractory anemia with sideroblasts


The peripheral blood may contain a minor population of hypochromic cells but will not show blasts. The bone marrow aspirate smear shows an increase in erythroid precursors with erythroid lineage dysplasia.

> or equal to 15% ringed sideroblasts in marrow
< 5% myeloblasts in marrow, not in blood
Erythroid dysplasia

Definitive Diagnostic Methods

Bone marrow biopsy
Peripheral blood smear

Genetics Data





Hematologic Transplant and/or Endocrine Procedures

Transformations from


Corresponding ICD-9 Codes

238.72 Low grade myelodysplastic syndrome lesions

Corresponding ICD-10 Codes

D46.1 Refractory anemia with sideroblasts

Corresponding ICD-10-CM Codes (U.S. only)

D46.1 Refractory anemia with sideroblasts (effective October 01, 2015)

Signs and Symptoms

Easy bruising or bleeding
Petechiae (flat, pinpoint spots under the skin caused by bleeding)
Shortness of breath
Skin paler than usual
Weakness or feeling tired

Diagnostic Exams

Blood chemistry studies
Cytogenetic analysis
FISH (flourescence in situ hybridzation)
Flow cytometry
Peripheral blood smear

Progression and Transformation

~1-2% of cases evolve to acute myeloid leukemia

Epidemiology and Mortality

Age: 60-73 years median age
Incidence: 3-11% of MDS cases
Sex: no male or female predominance
Survival: 69-108 months median survival


Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds):
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Myelodysplastic syndromes
Pages: 109-111

International Classification of Diseases for Oncology, Third Edition, Second Revision. Geneva: World Health Organization, 2020.
Section: ICD-O-3.2 (2020) Morphological Codes

National Cancer Institute
Section: General Information About Myelodysplastic Syndromes