Normocytic Anaemia

Question 1

Define normocytic anaemia

Answer 1

Anaemia associated with a normal MCV (76-96 fL) of RBC

Question 2

What are the causes/risk factors of normocytic anaemia?

Answer 2

AFH x2
• Acute blood loss
• Anaemia of chronic
disease
• Bone marrow Failure
• Renal Failure
• Haemolysis
• Hypothyroidism

Question 3

What are the signs and symptoms of normocytic anaemia?

Answer 3

The clinical features of anaemia. The history may demonstrate the cause (e.g. trauma, history of chronic disease, bone marrow suppression (chemotherapy and leukaemia) or pregnancy)

Question 4

What investigations are carried out for normocytic anaemia?

Answer 4

• FBC - low Hb; Normal MCV.
• Reticulocyte Count - hypoproliferative (<2%): Bone Marrow Failure, Aplastic Anaemia, CKD and Hypothyroidism. Also, ACD.
- Hyperproliferative (>2%): Haemorrhage and Haemolytic Anaemia.

Investigate the Cause:
• Hypoproliferative - an associated cytopaenia in the FBC is suggestive of bone marrow failure. This can be due to haematological malignancies e.g. leukaemia and myelodysplasia; chemotherapy which supresses bone marrow activity; or even radiotherapy.
• An isolated anaemia is more suggestive of renal failure, hypothyroidism and pure RBC aplasia. U&Es may be performed, in which urea and creatinine are suggestive of CKD. Low levels of Serum EPO are the cause of anaemia in CKD. TFTs may also be performed to diagnose hypothyroidism. If these investigations yield no results, or if the history and examination is not suggestive of CKD/ hypothyroidism, then Investigations for Aplastic Anaemia must be considered.
• Antibodies may be considered e.g. ANA and ANCA for conditions like SLE. Investigations into other autoimmune diseases may also be considered.

Hyperproliferative:
• Haemorrhage may be suggested by a history of trauma.
• History of prior episodes of GI bleeding, gastritis, NSAID or corticosteroid use, alcohol use, or cirrhosis should prompt suspicion of GI bleeding. In patients with upper GI bleeding, elevated Urea may be seen, even in absence of renal issues, due to digestion of blood, which is a source of urea. If GI bleeds are suspected then OGD and/or Colonoscopy should be promptly performed to diagnose the underlying problem.
• Another cause of hemorrhage may be a ruptures AAA. This is a medical emergency and will be suggested in the presentation of the patient.
• If acute bleeding is not indicated, then haemolysis should be suspected –see investigations for haemolytic anaemia.

Question 5

What is the management of normocytic anaemia?

Answer 5

• treat underlying cause

- blood transfusions may be indicated if patient’s Hb is <70g/L

Question 6

What are the complications of normocytic anaemia?

Answer 6

• high-output cardiac failure

* complications of the cause