Normocytic Anemia

Overview

What is normocytic anemia?

Normocytic anemia happens when you have fewer red blood cells than normal, and those blood cells don’t have the normal amount of hemoglobin. Hemoglobin is a protein in your red blood cells. It helps red blood cells carry oxygen throughout your body.

Healthcare providers may refer to normocytic anemia as a medical condition or as a sign of other conditions. Sometimes, people have normocytic anemia because they have an inherited condition. Most of the time, people develop normocytic anemia because they have an underlying chronic illness. Healthcare providers treat normocytic anemia by treating the underlying condition.

Symptoms and Causes

What causes normocytic anemia?

Three main things cause normocytic anemia. You may develop normocytic anemia if:

  • You’re losing blood. There are many reasons why you may lose blood, such as being injured or having a medical condition that causes internal bleeding. You can develop normocytic anemia if you have heavy periods.
  • You have a medical condition that affects your body’s ability to make enough red blood cells (red blood cell production.)
  • You have a medical condition that causes your red blood cells to break down faster than normal. This is hemolysis.

What medical conditions affect red blood cell production?

Your bone marrow makes stem cells that mature and become red blood cells, along with white blood cells and platelets. Your bone marrow normally produces enough red blood cells to maintain the steady flow your body needs. Some medical conditions may disrupt that process:

  • Anemia of chronic disease: This condition happens when you have an autoimmune disease or other condition that lasts longer than three months and causes inflammation. Healthcare providers may use the terms anemia of inflammation or anemia of inflammation and chronic disease.
  • Kidney disease: Your kidneys produce the hormone erythropoietin (EPO). EPO controls how and when your bone marrow makes red blood cells. If you have damaged kidneys, they make less EPO. That means your bone marrow makes fewer red blood cells, causing anemia.
  • Aplastic anemia: Aplastic anemia is a rare blood disorder that happens when stem cells in your bone marrow don’t create enough blood cells, including red blood cells.

What causes hemolysis in normocytic anemia?

Normal red blood cells live 120 days after they’re released into your bloodstream from your bone marrow. Abnormal red blood cells break down earlier than that. You may have abnormal blood cells because you inherited or developed certain conditions that make your red blood cells break down faster than normal. Examples include:

  • Sickle cell anemia: This inherited blood disorder affects red blood cells, turning normal blood cells into sickle cells that prevent blood flow.
  • Hereditary spherocytosis: This is a rare inherited blood disorder that causes hemolytic anemia. In hemolytic anemia, your red blood cells break down faster than your body can replace them.
  • Autoimmune hemolytic anemia: This rare immune disorder happens when your immune system mistakenly attacks your red blood cells.
  • Thrombotic thrombocytopenic purpura (TTP): TTP causes small blood clots throughout your body.
  • Disseminated intravascular coagulation (DIC): This blood clotting disorder can turn into uncontrollable bleeding.
  • G6PD Deficiency: This disorder affects levels of an enzyme that protects your red blood cells from harmful substances.

What are the symptoms of normocytic anemia?

Normocytic anemia symptoms take time to develop. You can have normocytic anemia and not notice any changes in your body. Symptoms you may notice include:

Diagnosis and Tests

How do healthcare providers diagnose normocytic anemia?

Healthcare providers use blood tests to diagnose normocytic anemia:

  • Complete blood count (CBC): This test gives healthcare providers information about your hemoglobin levels and aspects of your blood.
  • Peripheral blood smear: Healthcare providers do this test to identify the underlying condition that causes normocytic anemia.
  • Reticulocyte count: Healthcare providers measure reticulocytes to determine if your bone marrow is producing enough healthy red blood cells.

Normocytic anemia is a sign of an underlying and undiagnosed medical condition. If that’s your situation, your healthcare provider may do more tests to diagnose the underlying condition. For example, if your healthcare provider thinks you have normocytic anemia because you have chronic kidney disease, they may do other blood tests, urine protein tests or imaging tests.

Management and Treatment

How do healthcare providers treat normocytic anemia?

Healthcare providers treat normocytic anemia by treating the underlying condition. For example, if you have normocytic anemia because you have chronic kidney disease, healthcare providers will focus on treating the kidney disease, which should ease anemia symptoms. If you have severe anemia, they may prescribe medication that’ll help your bone marrow make more red blood cells.

Prevention

How can I prevent normocytic anemia?

Many conditions cause normocytic anemia. That makes it hard to predict if you’ll have normocytic anemia, much less prevent it. Normocytic anemia happens when you have a medical condition that causes anemia. While you probably can’t prevent normocytic anemia, you may be able to limit its impact. Ask your healthcare provider if your illness increases the chance you’ll develop normocytic anemia. If that’s the case, ask them about anemia symptoms, and let them know if you notice significant changes in your body that may be symptoms of anemia.

Outlook / Prognosis

What can I expect if I have normocytic anemia?

Normocytic anemia is a sign of many medical issues, some more serious than others. If you have normocytic anemia, your prognosis or expected outcome depends on factors like what kind of illness caused your anemia, how you’re responding to treatment for that illness and your general health.

Talk to your healthcare provider if you’re concerned about your prognosis. They’re your best resource for information about your situation.

Living With

If you have normocytic anemia, you’re probably already living with a chronic illness that comes with its own challenges. Normocytic anemia may be one more illness you have to manage. Here are some suggestions that may help:

  • Follow a healthy diet. Anemia often happens when you don’t get enough iron, vitamin B12 and vitamin B9 (folic acid). Ask your healthcare provider about vitamin supplements.
  • Anemia is exhausting. Try to get as much rest as you can.
  • Drink enough water to stay hydrated.
  • Do your best to avoid infections by washing your hands frequently.

A note from Cleveland Clinic

If you have normocytic anemia, you have fewer red blood cells than normal. You may learn this after a routine blood test or a blood test to find out why you have certain symptoms. Many times, normocytic anemia happens because you have a chronic illness that affects your red blood cells. You may have known about the illness, or it may come as an unwelcome surprise. Ask your healthcare provider to explain your test results and any next steps, so you know what to expect.

Last reviewed by a Cleveland Clinic medical professional on 05/10/2022.

References

  • American Family Physician. Anemia in Older Adults. (https://www.aafp.org/afp/2018/1001/p437.html?msclkid=e21ee0dac71711ec859a57c075af0ed1) Accessed 5/10/2022.
  • Familydoctor.org. Anemia. (https://familydoctor.org/condition/anemia/?msclkid=a05a6f02c71711ec8da0ced303c53232) Accessed 5/10/2022.
  • Maner BS, Moosavi L. Mean Corpuscular Volume. (https://www.ncbi.nlm.nih.gov/books/NBK545275/?msclkid=243f4d88c71811ecbecaa289ba5f553c) [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 5/10/2022.
  • Merck Manual. Overview of Anemia. (https://www.merckmanuals.com/home/blood-disorders/anemia/overview-of-anemia?msclkid=25b362b9c71611ecbe20e3d49dd4c3a0) Accessed 5/10/2022.
  • Merck Manual. Overview of Decreased Erythropoiesis. (https://www.merckmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/overview-of-decreased-erythropoiesis?msclkid=dfbf3d0fc71611ecaea22fee933c7a36) Accessed 5/10/2022.
  • Merck Manual. Red Blood Cell Production. (https://www.merckmanuals.com/professional/hematology-and-oncology/approach-to-the-patient-with-anemia/red-blood-cell-production?msclkid=86b9774ac71611ec8df508a731eb7ff5) Accessed 5/10/2022.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Anemia in Chronic Kidney Disease. (https://www.niddk.nih.gov/health-information/kidney-disease/anemia?msclkid=34f7b138c71711ec96f6f367da385952) Accessed 5/10/2022.

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