Normocytic Normochromic Anemia: Symptoms, Causes and Treatment

Normocytic normochromic anemia is a type of anemia in which the concentration of hemoglobin and the size of RBCs is normal but the RBC count is less. This is a kind of hypoproliferative anemia which is typically observed with a low reticulocyte production index along with no change in RBC morphology ( Reticulocyte index < 2-2.5). This kind of condition is very frequently seen in chronic diseases and hemolytic anemias. The symptoms are similar to any kind of anemias and it resolves when the underying disease is treated .

Normocytic Normochromic Anemia Symptoms

Anemia is frequently asymptomatic but there are some severe cases in which the symptoms can be more prominent. The symptoms of anemia are-

• Shortness of breath
• Lightheadedness
• Fatigue
• Paleness
• Headaches
• Brain fogging ( Difficulty in memory and concentration)
• Weakness
• Chest pain
• Syncope
• In normocytic anemia the other features of chronic diseases will also seen.

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Normocytic Normochromic Anemia Causes

There are various causes of Normocytic anemia and the number of reticulocytes and the clinical features can help us to suspect the cause. There are many inflammatory and chronic conditions in which normocytic anaemias develop as one of the reason is  there is inadequate supply of iron to the bone marrow. The one reason for normocytic normochromic anemia is due to decreased RBC lifespan. The primary disease determines the severity and the aspects/type of anemia. Anemia due to the hypometabolic state is caused due to suboptimal erythropoietin response to the anemia.

Conditions with normal or low Reticulocyte count- 

• Renal disease- Progressive CKD can lead to moderate to severe hypoproliferative anemia, the reason is the decrease in production of erythropoietin by kidneys.
• Liver disease
• Conditions with early B12 and folate deficiency
• Anemia of chronic disease
• Early stages of Iron deficiency anemia
• Protein malnutrition
• Systemic lupus eryhtematosis
• Endocrine deficiency
• Congenital Methylmalonic acidemia and aciduria
• Malignancies or any cancer treatment
• Bone marrow diseases like myelofibrosis
• Normocytic and normochromic anemia occurs in most of the myeloma patients and the reason for anemia can be due to inhibition of hematopoiesis by factors produced by tumor cells or due to reduced production of erythropoietin by kidneys.
• Rheumatoid Arthritis-  The severity of anemia goes concurrently with the the degree of inflammation, the levels of C-reactive protein and Erythrocyte Sedimentation rate.

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Conditions with increased Reticulocyte count

• Hemolysis like PNH, transfusion reactions, hemoglobinopathies, infections etc. In Acute hemolytic anemia there will be hemoglobinemia, hemoglobinuria and high LDH levels.
• Blood loss/Hemorrhage- Subacute blood loss is related to the modest reticulocytosis.
• Acute myelocytic leukemia
• Malaria
• Heavy menstrual bleeding

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Normocytic Normochromic Anemia Diagnosis

• Anemia is usually first determined using the routine blood test that is CBC count and then blood smear can confirm the shape and the size of the RBCs.
• Signs of the anemia like pale skin, weak pulse or low BP might be present.
• But to distinguish the type of anemia Mean Corpuscular Volume is calculated. If the value of MCV lies between 80-100 then it is Normochromic anemia.
• There should be proper clinical investigation to diagnose the underlying cause of the disease.
• In conditions like myelofibrosis , the diagnosis is done by leukoerythroblastic smear. ( Reticulocyte index <2-2.5)

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Normocytic Normochromic Anemia Treatment

• As we know the main cause of normocytic anemia is chronic disease therefore the main target should be to treat the causative disease like CKD, RA, SLE etc.
• In serious cases, Erythropoietin shots maybe required to stimulate the Bone Marrow.
• Blood transfusions in severe cases and the threshold for transfusion of blood among the geriatric age group should depend on condition of the patient and the cause of anemia. For instance, in the patient suffering from acute blood loss the threshold of blood transfusion should be <8mg/dl instead of 7mg/dl if the patient has any associated chronic disease.
• Control the blood loss if there is any.
• You need to consult a regular hematologist and taking iron pills for normocytic anemia can be harmful as it cause iron deposition. Therefore iron supplimentation can be given to the patients who has low iron serum levels.
• Dietry suppliments should be added if the patient has any deficiency of a particular vitamin.
• Treatment of anemia is very important because it can worsen any health conditions and it will be difficult to recover from any illness.

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