Normocytic normochromic anemia

by Jason Wasserman MD PhD FRCPC
March 30, 2025

Normocytic normochromic anemia is a type of anemia where the body has fewer red blood cells than normal. Still, these cells are normal in size (normocytic) and contain a typical amount of hemoglobin, the protein that carries oxygen (normochromic). Anemia occurs when there aren’t enough healthy red blood cells or the red blood cells do not have enough hemoglobin to carry adequate oxygen to the body’s tissues.

What are the symptoms of normocytic normochromic anemia?

Common symptoms of normocytic normochromatic anemia include:

  • Fatigue or weakness.
  • Shortness of breath.
  • Pale skin.
  • Dizziness or lightheadedness.
  • Rapid heartbeat.
  • Headaches.

Some individuals with mild anemia might not notice symptoms, and the condition could be discovered through routine blood tests.

What causes normocytic normochromic anemia?

Normocytic normochromic anemia has several possible causes, such as:

  • Chronic diseases (e.g., kidney disease, inflammatory disorders, or autoimmune diseases).
  • Sudden or chronic blood loss (from injury, surgery, or internal bleeding).
  • Bone marrow disorders (e.g., aplastic anemia).
  • Early stages of iron deficiency or vitamin deficiencies.
  • Conditions causing increased breakdown of red blood cells (hemolysis).

Determining the exact cause is essential for proper treatment.

How is this diagnosis made?

The diagnosis of normocytic normochromic anemia begins with a complete blood count (CBC), which measures red blood cells’ size and hemoglobin content.

Blood tests often show:

  • A decreased number of red blood cells or hemoglobin level.
  • Normal-sized red blood cells (mean corpuscular volume or MCV within normal limits).
  • Normal amount of hemoglobin per cell (mean corpuscular hemoglobin concentration or MCHC within normal limits).

Additional tests may be required to identify the specific cause, including tests for iron levels, kidney function, or bone marrow examination.

What does normocytic normochromic anemia look like under the microscope?

Under the microscope, red blood cells appear normal in shape, size, and color. They are not smaller or larger than normal cells and do not appear pale or overly dark. There is simply a reduced number of these otherwise normal-appearing cells.

How is normocytic normochromic anemia treated?

Treatment for normocytic normochromatic anemia depends on the underlying cause of the anemia. Common approaches include:

  • Managing chronic diseases or underlying conditions (such as improving kidney function or treating inflammatory disorders).
  • Addressing and stopping any blood loss, either through medication or surgical intervention
  • Medication to stimulate the production of red blood cells in some instances (e.g., erythropoietin for chronic kidney disease).
  • Blood transfusions, if anemia is severe or causing significant symptoms.

Proper diagnosis and tailored treatment can effectively manage symptoms and improve quality of life.

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