Normocytic anemia

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Normocytic anemia is a type of anemia and is a common issue that occurs for people typically over 85 years old. Its prevalence increases with age, reaching 44 percent in men older than 85 years. [1] The most common type of normocytic anemia is anemia of chronic disease. [1]

Contents

Classification

An anemia is normocytic when the red blood cells (RBCs) are of normal size. RBCs are normocytic when the mean corpuscular volume (MCV) is between 80 and 100 femtolitres (fL), which is within the normal and expected range. However, the hematocrit and hemoglobin are decreased. [1] In contrast, microcytic anemias are defined as an anemia with a mean corpuscular volume (MCV) less than 80 fL and macrocytic anemias have a mean corpuscular volume over 100 fL.

Diagnosis

To aid with determining the underlying cause of the normocytic anemia, a lab test is done on reticulocyte count. [2] A reticulocyte count that is high, normal or low will aid with the classification process. A high reticulocyte count signifies that bone marrow processes are normal. A low reticulocyte count would signify there is a problem at the level of the bone marrow, which produce the stem cells. Acute blood loss would result in a high reticulocyte count, as bone marrow processes are normal and the bone marrow responds accordingly to the body's need for blood.

Causes

The issue is thought of as representing any of the following:

Blood loss, suppressed production of RBCs or hemolysis represent most cases of normocytic anemia. In blood loss, morphologic findings are generally unremarkable, except after 12 to 24 hrs where polychromasia appears. For reduced production of RBCs, like with low erythropoietin, the RBC morphology is unremarkable. [4] Patients with disordered RBC production, e.g. myelodysplastic syndrome, may have a dual population of elliptocytes, teardrop cells, or other poikilocytes as well as a nucleated RBCs. Hemolysis will often demonstrate poikilocytes specific to a cause or mechanism, e.g. bite cells and/or blister cells for oxidative hemolysis, acanthocytes for pyruvate kinase deficiency or McLeod phenotype, sickle cells for sickle cell anemia, spherocytes for immune-mediated hemolysis or hereditary spherocytosis, elliptocytosis for iron deficiency or hereditary elliptocytosis and schistocytes for intravascular hemolysis. Many hemolytic anemias show multiple poikilocytes such as G6PD deficiency, which may show blister and bites cells as well as shistocytes. Neonatal hemolysis may not follow the classic patterns as in adults. [4]

Treatment

Treatment will depend on the cause of the normocytic anemia. Treatment for anemia due to chronic diseases, such as kidney disease, focus on healing the primary condition first. Dietary foods or supplements should be added if anemia is due to a lack of a particular vitamin. Erythropoietin may be considered if anemia is severe. Erythropoietin will stimulate the bone marrow to make more blood cells. [5]

Related Research Articles

<span class="mw-page-title-main">Anemia</span> Reduced ability of blood to carry oxygen

Anemia is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function. The name is derived from Ancient Greek ἀν- (an-) 'not' and αἷμα (haima) 'blood'.

<span class="mw-page-title-main">Complete blood count</span> Routine laboratory test of blood cells

A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and platelets, the concentration of hemoglobin, and the hematocrit. The red blood cell indices, which indicate the average size and hemoglobin content of red blood cells, are also reported, and a white blood cell differential, which counts the different types of white blood cells, may be included.

<span class="mw-page-title-main">Reticulocyte</span> Immature red blood cell

In hematology, reticulocytes are immature red blood cells (RBCs). In the process of erythropoiesis, reticulocytes develop and mature in the bone marrow and then circulate for about a day in the blood stream before developing into mature red blood cells. Like mature red blood cells, in mammals, reticulocytes do not have a cell nucleus. They are called reticulocytes because of a reticular (mesh-like) network of ribosomal RNA that becomes visible under a microscope with certain stains such as new methylene blue and Romanowsky stain.

<span class="mw-page-title-main">Hereditary spherocytosis</span> Genetic disorder causing red blood cells to be spherical

Hereditary spherocytosis (HS) is a congenital hemolytic disorder wherein a genetic mutation coding for a structural membrane protein phenotype causes the red blood cells to be sphere-shaped (spherocytosis), rather than the normal biconcave disk shape. This abnormal shape interferes with the cells' ability to flex during blood circulation, and also makes them more prone to rupture under osmotic stress, mechanical stress, or both. Cells with the dysfunctional proteins are degraded in the spleen, which leads to a shortage of erythrocytes and results in hemolytic anemia.

The mean corpuscular volume, or mean cell volume (MCV), is a measure of the average volume of a red blood corpuscle. The measure is obtained by multiplying a volume of blood by the proportion of blood that is cellular, and dividing that product by the number of erythrocytes in that volume. The mean corpuscular volume is a part of a standard complete blood count.

<span class="mw-page-title-main">Red blood cell distribution width</span> Measure of red blood cell volume variation as part of a standard blood test

Red blood cell distribution width (RDW), as well as various types thereof, is a measure of the range of variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. Red blood cells have an average volume of 80–100 femtoliters, but individual cell volumes vary even in healthy blood. Certain disorders, however, cause a significantly increased variation in cell size. Higher RDW values indicate greater variation in size. Normal reference range of RDW-CV in human red blood cells is 11.5–15.4%. If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia. It is mainly used to differentiate an anemia of mixed causes from an anemia of a single cause.

<span class="mw-page-title-main">Megaloblastic anemia</span> Medical condition

Megaloblastic anemia is a type of macrocytic anemia. An anemia is a red blood cell defect that can lead to an undersupply of oxygen. Megaloblastic anemia results from inhibition of DNA synthesis during red blood cell production. When DNA synthesis is impaired, the cell cycle cannot progress from the G2 growth stage to the mitosis (M) stage. This leads to continuing cell growth without division, which presents as macrocytosis. Megaloblastic anemia has a rather slow onset, especially when compared to that of other anemias. The defect in red cell DNA synthesis is most often due to hypovitaminosis, specifically vitamin B12 deficiency or folate deficiency. Loss of micronutrients may also be a cause.

<span class="mw-page-title-main">Reticulocytosis</span> Medical condition

Reticulocytosis is a laboratory finding in which the number of reticulocytes in the bloodstream is elevated. Reticulocytes account for approximately 0.5% to 2.5% of the total red blood cells in healthy adults and 2% to 6% in infants, but in reticulocytosis, this percentage rises. Reticulocytes are produced in the bone marrow and then released into the bloodstream, where they mature into fully developed red blood cells between 1-2 days. Reticulocytosis often reflects the body’s response to conditions rather than an independent disease process and can arise from a variety of causes such as blood loss or anemia.

<span class="mw-page-title-main">Microcytic anemia</span> Medical condition

Microcytic anaemia is any of several types of anemia characterized by smaller than normal red blood cells. The normal mean corpuscular volume is approximately 80–100 fL. When the MCV is <80 fL, the red cells are described as microcytic and when >100 fL, macrocytic. The MCV is the average red blood cell size.

<span class="mw-page-title-main">Macrocytosis</span> Medical condition

Macrocytosis is a condition where red blood cells are larger than normal. These enlarged cells, also known as macrocytes, are defined by a mean corpuscular volume (MCV) that exceeds the upper reference range established by the laboratory and hematology analyzer. Upon examination of a peripheral blood smear under microscope, these macrocytes appear larger than standard erythrocytes. Macrocytosis is a common morphological feature in neonatal peripheral blood. The presence of macrocytosis can indicate a range of conditions, from benign, treatable illnesses to more serious underlying disorders.

<span class="mw-page-title-main">Sideroblastic anemia</span> Medical condition

Sideroblastic anemia, or sideroachrestic anemia, is a form of anemia in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). In sideroblastic anemia, the body has iron available but cannot incorporate it into hemoglobin, which red blood cells need in order to transport oxygen efficiently. The disorder may be caused either by a genetic disorder or indirectly as part of myelodysplastic syndrome, which can develop into hematological malignancies.

The Mentzer index, described in 1973 by William C. Mentzer, is the MCV divided by the RBC count. It is said to be helpful in differentiating iron deficiency anemia from beta thalassemia trait.

Reticulocytopenia is the medical term for an abnormal decrease in circulating red blood cell precursors (reticulocytes) that can lead to anemia due to resulting low red blood cell (erythrocyte) production. Reticulocytopenia may be an isolated finding or it may not be associated with abnormalities in other hematopoietic cell lineages such as those that produce white blood cells (leukocytes) or platelets (thrombocytes), a decrease in all three of these lineages is referred to as pancytopenia.

<span class="mw-page-title-main">Anisocytosis</span> Medical condition

Anisocytosis is a medical term meaning that a patient's red blood cells are of unequal size. This is commonly found in anemia and other blood conditions. False diagnostic flagging may be triggered on a complete blood count by an elevated WBC count, agglutinated RBCs, RBC fragments, giant platelets or platelet clumps due to anisocytosis. In addition, it is a characteristic feature of bovine blood.

Macrocytic anemia is a class of anemia characterized by the presence of predominantly larger-than-normal red blood cells accompanied by low numbers of RBC and often also with insufficient hemoglobin content per cell. Macrocytic anemia occurs when – despite the larger cell size – such factors result in insufficient availability of hemoglobin for adequate oxygen transport.

Red blood cell indices are blood tests that provide information about the hemoglobin content and size of red blood cells. Abnormal values indicate the presence of anemia and which type of anemia it is.

Microcytosis or microcythemia is a condition in which red blood cells are unusually small as measured by their mean corpuscular volume.

Congenital hemolytic anemia (CHA) is a diverse group of rare hereditary conditions marked by decreased life expectancy and premature removal of erythrocytes from blood flow. Defects in erythrocyte membrane proteins and red cell enzyme metabolism, as well as changes at the level of erythrocyte precursors, lead to impaired bone marrow erythropoiesis. CHA is distinguished by variable anemia, chronic extravascular hemolysis, decreased erythrocyte life span, splenomegaly, jaundice, biliary lithiasis, and iron overload. Immune-mediated mechanisms may play a role in the pathogenesis of these uncommon diseases, despite the paucity of data regarding the immune system's involvement in CHAs.

Non-sideropenic hypochromic anemia also known as Normochromic Normocytic Anemia is a kind of anemia in which the red blood cells in circulation have a normal red color (normochromic) and the same size (normocytic). Normocytic normochromic anemia is most commonly caused by a variety of chronic infections and systemic diseases.

Anemia is a condition in which blood has a lower-than-normal amount of red blood cells or hemoglobin. Anemia in pregnancy is a decrease in the total red blood cells (RBCs) or hemoglobin in the blood during pregnancy. Anemia is an extremely common condition in pregnancy world-wide, conferring a number of health risks to mother and child. While anemia in pregnancy may be pathologic, in normal pregnancies, the increase in RBC mass is smaller than the increase in plasma volume, leading to a mild decrease in hemoglobin concentration referred to as physiologic anemia. Maternal signs and symptoms are usually non-specific, but can include: fatigue, pallor, dyspnea, palpitations, and dizziness. There are numerous well-known maternal consequences of anemia including: maternal cardiovascular strain, reduced physical and mental performance, reduced peripartum blood reserves, increased risk for peripartum blood product transfusion, and increased risk for maternal mortality.

References

  1. 1 2 3 4 Brill JR, Baumgardner DJ (November 2000). "Normocytic anemia". Am Fam Physician . 62 (10): 2255–64. PMID   11126852. Archived from the original on 2011-06-06. Retrieved 2008-07-12.
  2. ↑ Vieth, Julia (2017). "Anemia". Hematology/Oncology Clinics of North America. 31 (6): 1045–1060. doi:10.1016/j.hoc.2017.08.008. PMID   29078923 – via Elsevier Science Direct.
  3. 1 2 Medical Physiology by Kibble and Halsey p295
  4. 1 2 Ford, J. (June 2013). "Red blood cell morphology". International Journal of Laboratory Hematology. 35 (3): 351–357. doi: 10.1111/ijlh.12082 . PMID   23480230.
  5. ↑ "Normocytic anemia". MediGoo - Health Medical Tests and Free Health Medical Information. Retrieved 2020-12-28.
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