Normocytic Anaemia

Question 1

Define Normocytic Anaemia

Answer 1

Anaemia (reduced Hb) with a normal MCV (80-100fL)

Question 2

Aetiology of Normocytic Anaemia

Answer 2

Decreased blood volume or decreased erythropoiesis

Blood loss
Pregnancy

Hypoproliferative:
Haemotological malignancy
Aplastic anaemia
Hypothyroidism
Chronic renal failure
Bone marrow failure 

Anaemia of chronic disease: chronic infection, inflammatory/ connective tissue diseases/ malignancy
Early IDA

Hyperproliferative: Haemolytic anaemia: MAHA, AIHA, drugs, infection, inherited conditions, transfusion reactions, burns

Question 3

Symptoms of Normocytic Anaemia

Answer 3

Anaemia: SOB, lethargy/fatigue, light-headedness, pallor
Easy bruising 
Night sweats
Weight loss
Fever

Question 4

Signs of Normocytic Anaemia

Answer 4

Thombocytopenia: ecchymoses, petechiae
Fever
Lymphadenopathy 
Splenomegaly 
Jaundice (haemolytic anaemia)

Question 5

Investigations for Normocytic Anaemia

Answer 5

FBC: Hb reduced, MCV normal
Reticulocyte count:
>2% → reassess history for blood loss and evaluate for haemolytic anaemia
<2% → obtain iron studies, serum vit B12 and folate levels

Faecal occult blood testing: ? GI bleeds
Haptoglobin: reduced in haemolytic anaemia
LDH: raised in haemolytic anaemia
Unconjugate bilirubin: raised in haemolytic anaemia
Iron studies: identify IDA
B12 and folate levels

Bone marrow aspirate and biopsy: diagnosis of aplastic anaemia, myelodysplastic sydnrome, myeloproliferative neoplasm

Question 6

Management for normocytic anaemia

Answer 6

Identify and treat the underlying cause
Blood transfusion with RBCs for severe anaemia
Hb <7 g/dL
Hb < 8 g/dL with pre-existing cardiovascular disease or undergoing surgery
Consider hospital admission
Bone marrow transplantation may be indicated e.g. aplastic anaemia