Classification of Normocytic Anemia

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There are many causes of normocytic, normochromic anemia. It helps to use an organizing framework that sorts causes into big, then smaller buckets:

• Hypo- vs. hyperproliferative
  • Hyperproliferative:
    • Bleeding
    • Hemolysis
  • Hypoproliferative:
    • Nutrition
      • B12 deficiency
      • Folate deficiency
      • Fe deficiency
    • Inflammation
    • Organ dysfunction
      • Liver
      • Kidney
      • Endocrine
      • Bone marrow (BM)

Approach:

• Question 1: Appropriate vs. inappropriate retic response (appropriate defined by absolute retic count > 120 x 10^9/L or 0.12 x 10^12/L)?
• Question 2: If appropriate retic response, is there bleeding or hemolysis?
• Question 3: If inappropriate retic response, is there inflammation or organ dysfunction?
• Question 4: If organ dysfunction, is there chronic liver disease, chronic kidney disease, endocrinopathy or bone marrow dysfunction?
• Question 5: If endocrinopathy, is there hypothyroidism, hyperthyroidism, hypogonadism (among others)?
• Question 6: If bone marrow issue, is there MM, MDS, pure red cell aplasia (among others)?