Makindo Medical Notes

Related Subjects: |Sideroblastic Anaemia |Splenectomy |Paroxysmal Nocturnal Haemoglobinuria |Pernicious anaemia |Normocytic anaemiaa |Pyruvate Kinase deficiency |Blood Products - Platelets |Von Willebrand Disease

🩸 About Normocytic Anaemia

• Defined as reduced haemoglobin (Hb) with a normal MCV (80–100 fL) 📏.
• Red blood cells are normal in size/shape, but there is an underlying problem with production, survival, or loss.
• Symptoms reflect anaemia in general: fatigue, pallor, exertional dyspnoea, and in severe cases, tachycardia or chest pain ❤️‍🔥.
• Normocytic anaemia is often a “clue” to an underlying systemic disease rather than a primary haematological disorder.

⚠️ Common Causes of Normocytic Anaemia

• 🩸 Acute Blood Loss: GI bleed, trauma, retroperitoneal haemorrhage. Early Hb may be normal until fluids dilute.
• 🔥 Anaemia of Chronic Disease (ACD): Inflammation (RA, IBD, TB, malignancy). Iron trapped in macrophages → ↓ availability for RBC production.
• 🤰 Pregnancy: Physiological haemodilution from increased plasma volume. Monitor iron/folate to exclude combined deficiency.
• 💥 Haemolysis: Premature RBC destruction (autoimmune, malaria, hereditary spherocytosis, prosthetic valves). May see jaundice + ↑ reticulocytes.
• 🩺 Renal Disease: CKD → ↓ erythropoietin. Classically normochromic normocytic anaemia. Managed with ESA injections.
• 🧬 Malignancy: Bone marrow infiltration (leukaemia, lymphoma) or chemo/radiotherapy effect. Also paraneoplastic anaemia.
• 🦴 Bone Marrow Failure: Aplastic anaemia, myelodysplastic syndromes (MDS). Often associated with pancytopenia.

🔍 Investigations

• FBC: Confirms normocytic indices; check WCC/platelets for marrow involvement.
• U&E, LFTs: Renal/hepatic dysfunction as secondary causes.
• Iron Studies: Ferritin ↑ in ACD, ↓ in iron deficiency.
• B12/Folate: To rule out early macrocytic causes that may initially appear normocytic.
• Reticulocyte Count: High = blood loss/haemolysis 🔥, Low = marrow failure.
• LDH, Bilirubin, Haptoglobin: Evidence of haemolysis.
• Direct Antiglobulin Test (DAT/Coombs): If autoimmune haemolysis suspected.
• Bone Marrow Biopsy: If marrow infiltration, aplasia, or MDS suspected.

🧾 Additional Considerations

• Peripheral Smear: Spherocytes (AIHA), schistocytes (MAHA), blasts (leukaemia).
• CRP/ESR: Suggests inflammatory/autoimmune anaemia of chronic disease.
• Erythropoietin Levels: Low in CKD anaemia.
• Screening for Chronic Disease: Diabetes, RA, IBD, malignancy – often underlying causes.

💡 Exam Pearl: Think “blood loss, inflammation, haemolysis, kidneys, marrow” as the five major categories. Normocytic anaemia is never the final diagnosis – it’s always a pointer to something bigger 🚩.