For Sideroblastic anemia caused by medications such as chloramphenicol, isoniazid, pyrazinamide, and linezolid patient history will be key and may be confirmed by further laboratory analysis.
Confirming drug toxicity or poisoning that results in sideroblastic anemia will depend on the patient's history and chemical analysis confirming the presence of the offending chemical.
Alcohol poisoning can be confirmed through blood alcohol levels, while also having decreased levels of delta-aminolevulinic acid synthetase.
Sideroblastic anemia due to decreased copper/increased zinc and vitamin B6 deficiency can all be evaluated through specific chemistry testing blood levels of these compounds.
Lead poisoning confirmation is done by directly measuring lead levels in the blood. For children this may be done with a fingerstick, however, contamination is a risk if lead is on the skin surface and any increase should be confirmed with a venous sample. Greater than or equal to 3.5 μg/dL is considered significant for children 1-5 years old and ≥10 μg/dL is significant for adults. In addition, the measurement of accumulated ALA in the urine, red blood cell free erythrocyte protoporphyrin or zinc protoporphyrin will be increased. Early stages may not present with the classic dimorphic red blood cell population, therefore early testing in children with low hemoglobin levels is important. Coarse or punctate basophilic stippling is characteristic. Lead inhibits pyrimidine 5'-nucleotidase which normally will be involved in the breakdown of ribosomal ribonucleic acid (RNA). Instead, ribosomes aggregate forming heavier stippling.19
