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Normocytic Anemia
Aka: Normocytic Anemia, Anemia of Chronic Disease, Anemia of Inflammation, Anemia of Systemic Disease
- See Also
- Anemia
- Anemia Clinical Clues
- Anemia Evaluation
- Anemia in the Intensive Care Unit
- Pathophysiology
- Underlying mechanisms
- Inhibition of Renal Erythropoietin synthesis and release
- Decreased Bone Marrow responsiveness to Erythropoietin
- Macrophage iron sequestration
- Increased RBC destruction
- Timing
- Anemia in the Intensive Care Unit develops within days to weeks
- Other Anemia of Chronic Disease develops over a 1-2 month period
- Other Anemias may be concurrently present
- Folate Deficiency
- Iron Deficiency Anemia
- Strenuous physical exertion can cause Normocytic Anemia
- Plasma volume expands
- Red Blood Cell mass remains unchanged
- Evaluation
- MCV
- High normal MCV: Evaluate as Macrocytic Anemia
- Serum Vitamin B12
- Serum Folate
- Thyroid Stimulating Hormone (TSH)
- Low normal MCV: Evaluate as Microcytic Anemia
- Serum Ferritin
- Reticulocyte Count
- High Reticulocyte Count causes
- Obtain Hemolysis labs
- Serum Bilirubin
- Lactate Dehydrogenase
- Haptoglobin
- Positive Hemolysis labs
- Autoimmune Hemolysis
- Hemoglobinopathy (Hereditary Spherocytosis)
- Membrane disorders
- Enzyme defects
- Negative Hemolysis labs
- Bleeding without Iron Deficiency
- Hypersplenism
- Anemia recovery
- Normal Reticulocyte Count (suggests Bone Marrow hypofunction)
- Medical disease
- Consider Renal Function tests, Liver Function Tests, TSH
- Consider Erythropoietin
- Inflammation
- See Anemia of Chronic Disease causes below
- Bone Marrow disorder
- Leukemia
- Myelofibrosis
- Causes: Anemia of Chronic Disease
- Chronic Inflammation
- Infection
- Connective Tissue Disease (e.g. Rheumatoid Arthritis)
- Malignancy (excluding direct blood loss from cancer)
- Chronic Renal Failure
- Endocrine Failure (e.g. Hypopituitarism, Hypothyroidism)
- Hepatic disease
- Labs
- Complete Blood Count
- See Hemoglobin Cutoffs for Anemia
- See Hematocrit Cutoffs for Anemia
- Hemoglobin (7-11 g/dl) suggests moderate Anemia
- Mean Corpuscular Volume (MCV) normal (80 to 100 fl)
- MCV cutoff varies by age and per reference
- Iron Indices reduced
- Serum Iron reduced
- Total Iron Binding Capacity reduced
- Iron Saturation variably low or normal
- Serum Transferrin decreased
- Serum Ferritin
- Decreased if Iron Deficiency Anemia
- Serum Ferritin increases as an acute phase reactant, a marker of systemic inflammation
- Bone Marrow Aspiration
- Resources
- Information from your Family Doctor: Normocytic Anemia
- http://www.familydoctor.org/handouts/639.html
- References
- Marino (2014) The ICU Book, p. 351
- Brill (2000) Am Fam Physician 62(10):2255-63 [PubMed]
- Wang (2016) Am Fam Physician 93(4): 270-8 [PubMed]