Normocytic Anemia

Normocytic anemia develops when you have low levels of healthy red blood cells and low hemoglobin levels. Hemoglobin is a protein in your red blood cells. It helps the cells carry oxygen throughout your body. Healthcare providers may refer to normocytic anemia as a medical condition or as a sign of another health condition. Without treatment, severe forms of this condition can lead to heart failure and other cardiovascular issues.

Symptoms of this condition

Normocytic anemia may not cause symptoms. You may find out you have it after a routine blood test. If you do have symptoms, they may include:

• Fatigue and weakness
• Dizziness
• Fast heartbeat
• Pale skin, dry skin, or skin that bruises easily
• Shortness of breath

Normocytic anemia causes

You may develop this condition if:

• You lose blood because you have an injury or internal bleeding.
• You have a medical condition that affects your body’s ability to make enough red blood cells.
• You have a condition that causes hemolysis, when your red blood cells break down faster than normal.

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. Normally, your bone marrow makes enough red blood cells to maintain the steady flow your body needs. Medical conditions that can affect that process include:

• Anemia of chronic disease: This condition happens when you have an autoimmune disease or other condition that causes inflammation and lasts longer than three months.
• Aplastic anemia: This rare blood disorder affects stem cells in your bone marrow so the cells can’t make enough blood cells, including red blood cells.
• Kidney disease: This disease can reduce the amount of the hormone erythropoietin (EPO) that your kidneys make. EPO controls how and when your bone marrow makes red blood cells. Kidney disease can reduce the amount of EPO your kidneys make.

What causes hemolysis in normocytic anemia?

Hemolysis is when you have abnormal red blood cells that break down or die earlier than usual. Conditions that trigger hemolysis include:

• Autoimmune hemolytic anemia: In this disease, your immune system mistakenly attacks your red blood cells.
• Disseminated intravascular coagulation (DIC): This blood-clotting disorder can turn into uncontrollable bleeding, along with breaking down red blood cells.
• Hereditary spherocytosis: This rare inherited blood disorder destroys your red blood cells faster than your bone marrow can replace them.
• G6PD deficiency: This disorder affects levels of an enzyme that protects your red blood cells from harmful substances.
• Sickle cell anemia: This blood disorder turns normal red blood cells into sickle cells that prevent blood flow.
• Thrombotic thrombocytopenic purpura (TTP): TTP causes small blood clots throughout your body that break down red cells.

How doctors diagnose this condition

Healthcare providers do blood tests to diagnose normocytic anemia, including:

• CBC: This test can measure hemoglobin levels and give your provider information about your blood cells.
• Peripheral blood smear: This test helps providers identify the underlying condition that causes normocytic anemia.
• Reticulocyte count: This test counts immature red blood cells (reticulocytes) to see if your bone marrow is producing enough healthy red blood cells.

Your provider may do other tests to diagnose the underlying condition. For example, if they think the culprit is chronic kidney disease, they may do different blood tests, urine protein tests or imaging tests, like CT scans.

How is this condition treated?

Normocytic anemia treatment focuses on the underlying condition. For example, if you have aplastic anemia, your treatment may include antibiotics, blood transfusions and immunosuppressants. Your healthcare provider will do different treatments if you have a condition that makes your red blood cells break down, like DIC. You may receive anticoagulant medication or plasma transfusions.

When should I seek care?

Talk to a healthcare provider if you feel breathless (short of breath) or if you’re always tired, no matter how much rest you get. Many things cause these symptoms, including normocytic anemia and some underlying conditions.

What can I expect if I have this condition?

Several medical issues can cause normocytic anemia. Some are more serious than others. Your prognosis, or what you can expect from treatment, depends on factors like the specific underlying condition, your response to treatment and your general health.

Your situation may be different from someone else with normocytic anemia. Your healthcare provider is your best source of information. They’ll understand your concerns and will take time to answer your questions.

Is there anything I can do to feel better?

Like many forms of anemia, normocytic anemia can make you feel very tired. If you’re dragging through your day, take a break and get some rest. Make getting enough sleep your top priority. There are other things you can do to help you feel better:

• Eat well: Focus on iron-rich foods, like lean beef and chicken, fish, legumes, lentils and peas, and dark leafy greens. 
• Avoid infections: Wash your hands and avoid being around others if you or they aren’t well. Ask your healthcare provider about recommended vaccinations.

Can vitamin deficiencies cause normocytic anemia?

Lack of iron and vitamins B12 and B9 may lead to anemia, but may not directly cause normocytic anemia. One study found low levels of iron and vitamin B12 in about 1 out of 10 people with normocytic anemia.

What’s the difference between normocytic anemia and anemia?

“Anemia” is an overarching term for low levels of red blood cells. In normocytic anemia, you have low red blood cell levels, but the cells are normal in terms of size.