Normocytic Anemia Causes Mnemonic

The body’s response to a chronic disease state is to store iron outside of the blood with molecules of ferritin. Although the body may have iron stored away, it is unavailable for hemoglobin synthesis, leading to a normocytic anemia. Of note, a minority of patients with anemia of chronic disease will actually have a microcytic anemia, typically seen late in the course of disease.

In aplastic anemia, the bone marrow fails to produce all types of cells including RBCs, WBCs, and platelets. Patients with aplastic anemia are prone to anemia, infection, and bleeding due to the deficiency of these cell lines. Aplastic anemia is most often idiopathic in nature, but can be caused by exposure to chemotherapeutic drugs, radiation, chloramphenicol, industrial chemicals, such as benzene, and viral infections, such as EBV, CMV, and parvovirus.

Erythropoietin (EPO) is a growth factor hormone produced in the proximal convoluted tubules of the kidneys, which accelerates RBC production. In chronic kidney disease, EPO production is decreased and RBC production is slowed, leading to a normocytic anemia.

Initially, as serum iron and iron stored in ferritin decrease, patients with iron deficiency have normocytic anemia. However, as the quantity of iron further decreases and hemoglobin precursors become sparse, a microcytic anemia occurs.