What Is Normocytic Anemia?

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Normocytic anemia is a low number of red blood cells, which carry oxygen throughout the body. Most of the red blood cells in normocytic anemia are normal in size, and they are usually normochromic (normal color).

This common type of anemia can occur due to chronic disease, blood loss, or hemolysis (a condition in which the red blood cells break open and are destroyed). Normocytic anemia can be identified with a blood test. Identifying the cause and getting treatment are important aspects of managing normocytic anemia. 

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What Are the Symptoms of Normocytic Anemia? 

The effects of normocytic anemia can range from mild to severe, depending on the red blood cell count and other medical conditions that can add to your symptoms. You may experience symptoms gradually over time if the anemia is slowly progressive, but the symptoms can worsen abruptly if the anemia develops rapidly. 

Common symptoms of normocytic anemia: 

  • Fatigue, low energy 
  • General feeling of being weak 
  • Pale skin 
  • Dizziness 
  • Headaches 
  • Brain fog (difficulty with concentration and memory)
  • Lack of motivation

You can expect to have several of these symptoms with normocytic anemia, and some people only experience a few of the effects, especially if the anemia is mild. 

You may also experience other symptoms that aren’t necessarily directly related to the anemia, but they can signal the cause of the anemia. 

Associated symptoms can include:

  • Fever can occur due to an infection. 
  • Blood in the stool or dark stools can occur due to gastrointestinal (digestive tract) disease.
  • Coughing up blood can occur with lung cancer or esophageal (food tube) cancer. 
  • Weight loss can occur with cancer or chronic disease. 
  • Shortness of breath can occur if you also have chronic obstructive pulmonary disease (COPD, irreversible inflammatory lung disease) or heart disease. 

Normocytic anemia is a common complication of many different illnesses, and the associated symptoms can begin before or after the symptoms of anemia.

What Causes Normocytic Anemia?

Normocytic anemia occurs when the body has a lower-than-normal amount of red blood cells. This can happen due to bleeding, chronic disease, or low red blood cell production.

There are many different causes, and the condition can be more severe if you have more than one cause. 

Common causes of normocytic anemia:

  • Heavy menstrual bleeding 
  • Chronic bleeding, usually due to a gastrointestinal problem 
  • Bleeding from an injury 
  • Chronic kidney, heart, or liver disease 
  • COPD
  • Hemolysis (premature destruction of the red blood cells) due to sickle cell disease or an infection
  • Cancer or cancer treatment
  • Bone marrow disease 

Chronic disease may shorten the lifespan of red blood cells, which contributes to anemia.

Sometimes the cause and risk of low red blood cells are known before normocytic anemia becomes symptomatic. Or, symptoms of anemia may begin or the red blood cell count can be diagnostic of anemia before the causative condition is known. 

Monitoring

If you are at a known risk of anemia, your doctor may order blood tests to monitor your red blood cell count.

How Is Normocytic Anemia Diagnosed? 

The diagnosis of normocytic anemia is established with blood tests. If you have a serious injury with a substantial amount of blood loss, you would have a complete blood count (CBC), which would provide quick information about whether you have anemia. 

You may have a blood test to evaluate your red blood cell count if you have symptoms or physical examination findings that raise concerns that you could have anemia. Sometimes, normocytic anemia is diagnosed incidentally due to a routine CBC blood test done for a checkup.

Signs of anemia that your doctor may detect on your physical examination include pale skin, a rapid pulse, a weak pulse, or low blood pressure

Blood tests that detect anemia:

  • CBC: This blood test provides a count of your red blood cells, white blood cells, and platelets, as well as a general assessment of the average red blood cell size. According to the World Health Organization, a normal hemoglobin level for adult males is above 130 grams per deciliter (g/dL), for adult females and children over age 12, it is above 120 grams per deciliter, for children age 5 to 11, it is over 115 grams per deciliter, and for children under age 5 it is above 110 grams per deciliter.
  • Blood smear: This is a microscopic evaluation of the cells in a blood sample. Laboratory analysis of the sample will describe the shape and size of your red blood cells, as well as the characteristics of the other cells in the sample. 

Some types of anemia are microcytic (the red blood cells are small) and some are macrocytic (the red blood cells are large). These changes in size are usually due to different underlying issues than the causes of normocytic anemia, so the size of the red blood cells can help determine the cause of anemia.

For example, iron deficiency is a common cause of microcytic anemia (the red blood cells are small), while vitamin B12 deficiency is a common cause of macrocytic anemia (the red blood cells are too big).

The diagnosis of normocytic anemia often involves a search for the cause if it isn’t already known. 

Tests you might have during your assessment may include:

  • Electrolyte tests: This blood test may show signs of systemic diseases, such as kidney disease. 
  • Liver function tests: These blood tests may show signs of liver disease. 
  • Urinalysis (urine test): This test can show signs of blood or infection in your urine. 
  • Stool sample or rectal examination: These tests can detect bleeding in the gastrointestinal tract. 
  • A cervical examination: This test would be considered for people with a uterus (womb) if there is concern about excessive uterine bleeding. 
  • Imaging tests: Imaging tests, such as an abdominal computerized tomography (CT) scan, may show tumors or other structural problems or sources of bleeding. 

The diagnostic tests that your doctor would order during your anemia assessment would be guided by your symptoms, medical history, and physical examination. 

What Are the Treatments for Normocytic Anemia? 

Treatment of normocytic anemia can include controlling blood loss, treatment of underlying disease, blood transfusion, and medication to promote your red blood cell production. You would likely benefit from one or more of these treatments, and most people do not need all of them. 

  • Blood transfusion: This therapy is a direct infusion of donor blood. It is needed when the red blood count is very low. If you have developed anemia due to trauma, for example, your red blood cell count might normalize after your transfusion and after your bleeding stops. 
  • Surgical repair: Large traumatic wounds might not heal on their own and may need to be urgently surgically repaired to stop blood loss.
  • Erythropoietin: The kidneys naturally produce this hormone to stimulate red blood cell production in the bone marrow. In some situations, such as chronic kidney disease or cancer, it can also be used as a medication to help increase red blood cells. 
  • Treatment of underlying disease: If your anemia is due to a medical condition, such as COPD, liver disease, heart disease, kidney disease, or cancer, treatment of the underlying condition may help with symptoms of anemia, and your red blood cell count may improve as well. 

Treatment for anemia is important, even if you don't have symptoms. Anemia can worsen your overall health and make it harder for you to recover from illnesses.

Prognosis: What to Expect? 

Red blood cells last for an average of 120 days. Your red blood cell count should improve within a few weeks with treatment. 

If the cause of your anemia is acute (sudden and short-term), such as trauma, then you are likely to have lasting improvement after short-term treatment to alleviate blood loss and after a blood transfusion if your anemia is severe. 

Chronic normocytic anemia may require consistent treatment of the underlying cause so the red blood cell count will become normal and prevent anemia's recurrence. Lifestyle approaches can help you maintain a healthy red blood cell count as well.

Summary 

Anemia is low red blood cell number or function. Normocytic anemia is a common type of anemia with a low red blood cell count and normal-sized red blood cells. It can develop due to blood loss, low red blood cell production, or chronic disease.

Red blood cell loss can often be stopped with medical or surgical interventions. The symptoms and red blood cell count will usually improve with treatment of the cause of anemia. 

A Word From Verywell 

Anemia is often described based on the features of the red blood cells, which include size, shape, and color. Normocytic anemia is a common type of anemia with normal size red blood cells and usually normal shape and color as well.

This condition is a common effect of many different medical problems. If you are diagnosed with normocytic anemia, it is important to get treatment and maintain treatment of both your anemia and the underlying cause for your overall health.

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