Definition:
Haemoglobin below the normal range associated with a normal MCV
The principle cause of normocytic anaemia is the anaemia of chronic disorders (ACD). ACD is diagnosed in patients with anaemia, low-normal or low MCV, normal or increased ferritin*, raised ESR and low-normal/low iron and low-normal/low transferrin ≤3.0 g/l. This is caused by chronic infective or inflammatory disorders.
*Ferritin is an acute phase protein so can be increased in inflammatory states; a low ferritin is diagnostic of iron deficiency, but a normal ferritin does not exclude iron deficiency.
C.M & L.W 31-07-23
Who to refer:
- Patients whose anaemia remains unexplained following the recommended primary care investigations or if unresponsive to haematinic replacement
- Anaemia with increased reticulocyte count
- Anaemia where blood film suggests myelodysplasia (MDS)
Who not to refer:
- Anaemia due to haematinic deficiency if responsive to appropriate replacement
- For proven anaemia of chronic disorders (see definition above) – investigate for underlying cause based on patient’s symptoms and clinical findings.
How to refer:
SCI gateway to the Department of Haematology at WGH, St Johns or RIE.
Primary care investigations
- Blood film
- U&Es and LFTs
- Thyroid function tests
- B12 and folate. Treat if deficiency is detected
- Ferritin. Treat if deficiency is detected and consult separate Anaemia due to iron deficiency GP Referral Guideline for further management
- If ferritin normal check iron and transferrin on a fasting blood sample (take sample in morning with nothing to eat and only water to drink since midnight)
- If serum iron is low and transferrin ≥3.0 g/l on a fasting sample, this is diagnostic of iron deficiency – treat and consult Anaemia due to iron deficiency GP Referral Guideline for further management
- Reticulocyte count.
- Immunoglobulins and serum protein electrophoresis
