See Also
Evaluation
1. MCV
  1. High normal MCV: Evaluate as Macrocytic Anemia
    1. Serum Vitamin B12
    2. Serum Folate
    3. Thyroid Stimulating Hormone (TSH)
  2. Low normal MCV: Evaluate as Microcytic Anemia
    1. Serum Ferritin
2. Reticulocyte Count
  1. High Reticulocyte Count causes
    1. Hemolysis (e.g. Autoimmune Hemolysis, Hereditary Spherocytosis)
    2. Bleeding without iron deficiency
    3. Recovery
  2. Normal Reticulocyte Count
    1. See Anemia of chronic disease below
    2. Consider labs for primary cause (e.g. Erythropoietin)
Causes: Anemia of chronic disease
1. Chronic Inflammation
  1. Infection
  2. Connective Tissue disease (e.g. Rheumatoid Arthritis)
  3. Malignancy (excluding direct blood loss from cancer)
2. Chronic Renal Failure
3. Endocrine Failure (e.g. Hypopituitarism)
4. Hepatic disease
Pathophysiology
1. Related etiologies
  1. Changes in iron metabolism
  2. Decreased Erythropoietin synthesis
2. Develops over 1-2 month period
3. Other Anemias may be concurrently present
  1. Folate Deficiency
  2. Iron Deficiency Anemia
4. Strenuous physical exertion can cause normocytic Anemia
  1. Plasma volume expands
  2. Red Blood Cell mass remains unchanged
Labs
1. Complete Blood Count
  1. See Hemoglobin Cutoffs for Anemia
  2. See Hematocrit Cutoffs for Anemia
  3. Hemoglobin (7-11 g/dl) suggests moderate Anemia
  4. Mean Corpuscular Volume (MCV) normal (80 to 100 fl)
    1. MCV cutoff varies by age and per reference
2. Iron Indices reduced
  1. Serum Iron reduced
  2. Total Iron Binding Capacity reduced
  3. Iron Saturation variably low or normal
  4. Serum Ferritin reduced if Iron Deficiency Anemia
3. Bone Marrow Aspiration
Resources
1. Information from your Family Doctor: Normocytic Anemia
  1. http://www.familydoctor.org/handouts/639.html
References
1. Brill (2000) Am Fam Physician 62(10):2255

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