Normocytic anaemia
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|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 🚩.
