Normocytic Anemia: Causes, Symptoms, And Treatment - Job

Normocytic anemia affects your body's ability to maintain proper oxygenation. It’s one of the most common forms of anemia, occurring most in anemic adult men and postmenopausal women.

In a healthy person, red blood cells (RBCs) carry oxygen from the lungs through the bloodstream to body tissues. This processes carbon dioxide from the tissues, carrying it back to the lungs through the blood. 

Hemoglobin (Hb) is a major protein found in a red blood cell. Hb is the key to carrying oxygen, and RBCs would not function without hemoglobin.

Anemia occurs when there is a decrease in RBCs or Hb levels. Red blood cell size, shape, and hemoglobin content can also change depending on the anemia type. These differences help healthcare providers diagnose the exact condition and cause.

What does normocytic mean?

When circulating red blood cells are normal in size and volume, they’re normocytic.

Normocytic anemia is typically the result of another disease. Doctors can further classify it by checking the percentage of developing blood cells to see if your body is compensating for the issue. 

The anemia is hypoproliferative if your body doesn’t develop blood cells at high enough rates, at less than 2% of all red blood cells.

It’s hyperproliferative if your body is over-producing red blood cells, at more than 2% of all red blood cells. 

Normocytic anemia is typically hypoproliferative. However, it can be hyperproliferative in cases of red blood cell destruction (hemolysis) or bleeding.

Typical causes include:

• Nutrient deficiencies

• Multifactorial (e.g., combined vitamin B12 and iron deficiency) 

• Anemia of chronic disease

• Anemia of chronic kidney disease

• Anemia of heart failure

• Hypothyroidism

• Cancer-associated anemia

• Early blood loss that hasn’t caused iron deficiency

• Partially treated anemia

• Acute blood loss

• Diseases that cause hemolysis, such as sickle cell anemia

• Bone marrow failure syndromes

• Leukemias

• Aplastic anemia

• Pure red blood cell aplasia

How serious is normocytic anemia?

While the condition is typically not severe, it can progress and cause other issues. Bone marrow failure, cancer, and autoimmune disorders can make normocytic anemia harder to treat if they’re the underlying cause.

What are the causes of normocytic anemia?

Normocytic anemia either occurs when there are: 

• Too few red blood cells, or 

• Enough red blood cells but too little hemoglobin 

Insufficient red blood cell production appears to cause most cases of normocytic anemia. 

You can be born with normocytic anemia (congenital) or acquire the condition through disease or underlying infection.

Underlying conditions

Normocytic anemia usually develops as a result of systemic disease and chronic infections. 

Underlying causes of normocytic anemia can include cancer, autoimmune disorders, and chronic kidney disease. Medical conditions resulting in faster-than-normal red blood cell breakdown can also contribute.

Losing large amounts of blood through injury, internal bleeding, or heavy menstrual periods can also lead to normocytic anemia. 

The role of inflammation in normocytic anemia

Anemia of inflammation affects people with chronic diseases. 

In this type of anemia, you may have normal or increased iron levels in muscle tissue, but it cannot move into your blood because of inflammation. 

Researchers believe this unavailability of iron is an evolutionary defense strategy to limit iron availability to invading microbes.¹

This type of anemia is prevalent in people with autoimmune disorders. It’s the most frequently diagnosed form of anemia in hospitalized or chronically ill people. 

Anemia of inflammation can occur in people with congestive heart failure, chronic pulmonary difficulties, and obesity. 

What are the symptoms of normocytic anemia?

Normocytic anemia symptoms often slowly develop and depend upon the underlying illness. Common symptoms of anemia can include:

• Fatigue

• Dizziness

• Lightheadedness

• Shortness of breath

• Exercise intolerance

• A general feeling of weakness

• Heart palpitations

• Headaches

• Inability to concentrate

Signs that may indicate the presence of anemia

Upon physical examination, a medical provider will look for signs that may indicate the presence of anemia or an underlying cause. These signs may include:

• Pale skin, lips, palms, and nail beds

• Drop in blood pressure going from lying down to sitting up (postural hypotension)

• Yellowing of the eyes or skin (jaundice)

• Enlarged spleen (splenomegaly)

Anemia and hemolysis

Hemolysis is the premature destruction of red blood cells, and it can have numerous causes. It can lead to anemia, as well as normocytic anemia. If your body compensates for the issue, it doesn’t always cause anemia. 

Anemia is a common condition that doctors typically diagnose via routine blood work. It affects approximately 20 million people in the United States. 

A recent study found that women and Black people are most likely to suffer from anemia. The same study found that anemia occurs at 6.4 times the population rate in Black women.²

While rates of anemia tend to increase with age for both sexes, men have anemia at higher rates than women in the 75 and older age bracket.³

A healthcare provider will order a complete blood count (CBC) differential blood test to determine if you have normocytic anemia. 

Other tests can include a peripheral blood smear and reticulocyte count. These determine if the bone marrow is: 

• Producing enough RBCs for your body to function properly

• Responding to anemia properly

• Producing RBCs in the right shape 

What are the types of normocytic anemia?

The most common form of normocytic anemia is anemia of chronic disease (ACD), which occurs with a broad range of disorders, such as:

• Critical illness and major trauma

• Acute infections (e.g., COVID-19, pneumonia, endocarditis)

• Chronic infections (e.g., tuberculosis, hepatitis, HIV, osteomyelitis)

• Chronic disease (e.g., chronic pulmonary disease)

• Malignancy (e.g., lymphomas, sarcomas))

• Collagen vascular and autoimmune disorders (e.g., RA, SLE)

Other types of anemia

Hemolytic anemia: 

• Sickle cell anemia 

• Anemia due to enzyme deficiencies (e.g. G6PD deficiency) 

• Autoimmune disorders

Nonhemolytic anemias:

• Anemia of chronic kidney disease

• Iron deficiency anemia

• Anemia of chronic disease

Pernicious anemia:

• A type of anemia stemming from vitamin B12 deficiency

Is normocytic anemia curable?

Normocytic anemia can signify a more significant illness. The outcome depends on the cause of the anemia and how your body responds to treatment for that illness.

What is normocytic anemia treatment?

To treat normocytic anemia, physicians start by identifying the underlying illness causing the condition. Taking care of the initial problem should alleviate anemia symptoms. 

However, if the anemia is severe and causing issues, your doctor may opt for a blood transfusion before treating the underlying condition.

Lifestyle measures

You can make lifestyle changes to reduce your risk of anemia and complement treatment. 

It’s wise to follow a diet with a healthy supply of vitamin B12, vitamin B9, folic acid, and iron. 

To boost your vitamin and mineral intake, eat foods such as: 

• Red meat

• Asparagus

• Beans

• Dried apricots

• Almonds

• Broccoli

• Spinach

• Lima beans

• Enriched bread and cereals.

You can take vitamin supplements your healthcare provider prescribes, get vaccinated to protect against infections, and stay hydrated.

The lowdown

Contact your medical provider if you’re experiencing fatigue or general weakness. These are common symptoms of normocytic anemia. A complete blood count can quickly determine if you have this condition.

Normocytic anemia is often a sign of a more serious illness, so it’s essential to seek medical attention before symptoms worsen. 

Your physician can provide recommendations for treatment of the underlying condition to reduce common normocytic anemia problems.