The disease used to be called anemia of chronic inflammation because the underlying cause anemia is the continuous inflammation generated by chronic disease, which impairs iron metabolism and, in turn, RBC production.
First, they damage the RBC membrane, resulting in intramedullary hemolysis, or RBC breakdown in the bone marrow; or extravascular hemolysis, when RBCs are destroyed by macrophages in the spleen.
The law says that tests should be carried out every year, but RBC said operations were called off in 2020 due to problems caused by the COVID-19 pandemic.
In the bone marrow, immature RBC's mitochondria surround the nucleus and get laden with excess iron deposits, which produces ringed sideroblasts on histology, hence the name of the disease.
The most important one, and the one that most researchers agree upon, involves dysregulation of iron homeostasis and the signals that control RBC production.