In Nutan Agrawal et al study, anaemia was present in 94% of cases and in majority of these cases, anaemia was normocytic normochromic
In laboratory evidences, normochromic
and normocytic anemia, normalized number of reticulocytes formed by reticulocytosis, which the response of the bone marrow to the increased peripheral degradation, is >5% (2).
On the basis of red cell indices (mean corpuscular volume [MCV]), patients having anemia were further classified as normocytic normochromic
(MCV 80-96 fl), microcytic hypochromic (MCV <80 fl), and macrocytic (MCV >96 fl) and were investigated to find the etiology as well as to rule out any secondary causes of anemia, if found such patients were excluded from the study.
At the time of hospitalization, the patient had no abdominal pain and hematemesis but showed marked normochromic
anemia [hemoglobin, 66 (normal range: 113-151) g/L; mean corpuscular volume (MCV), 91.5 fL (normal range: 84.0-94.0) fL; mean corpuscular hemoglobin (MCH), 28.0 (normal range: 27.0-34.0) pg], and her leukocyte and platelet counts were normal.
Hematologic abnormalities included hypochromic macrocytic anemia (47%), normochromic
normocytic anemia (29.4%), normochromic
macrocytic anemia (5.9%), and hypochromic normocytic anemia (5.9%), and two animals (12%) presented PCV values at the lower reference limit.
His liver function tests, renal function tests, and complete blood count, were within normal limits except normocytic normochromic
anemia having hemoglobin level of 10.1 g/dl (normal: 12-16 g/dl).
The anaemia is usually normocytic and normochromic
, but can be microcytic in approximately one-third of cases due to long-standing iron restriction at the macrophage level.
Hence, anaemia was classified based on mean corpuscular volume (MCV) and/or mean corpuscular haemoglobin (MCH) into (i) normocytic normochromic
types (MCV [greater than or equal to] 80 but <100 fl; MCH [greater than or equal to] 27 pg): primary aetiology likely to be anaemia of chronic disease, (ii) microcytic (MCV < 80 fl) and/or hypochromic types (MCH < 27 pg): possible iron deficiency, and (iii) macrocytic types (MCV [greater than or equal to] 100 fl): possible folate or B12 deficiency.
Laboratory findings include elevated acute phase reactants, leukocytosis, thrombocytosis, and normocytic normochromic
Complete blood count with differential showed normocytic normochromic
anemia with haemoglobin of 13.2 mg/dl (normal range 13.5-18 mg/dl), white cell count of 8800/cu mm (normal range 4500-11000/cumm), and platelets of 253,000/cumm (normal range 140,000-450,000/cumm).
A recent peripheral blood film revealed normochromic
, normocytic anaemia, and serum ferritin was normal.
Caption: FIGURE 1: Peripheral blood smear with normocytic normochromic
red blood cells.