{"id":3701,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/anaemia-normocytic\/"},"modified":"2023-07-31T11:13:43","modified_gmt":"2023-07-31T10:13:43","slug":"anaemia-normocytic","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anaemia\/anaemia-normocytic\/","title":{"rendered":"Anaemia-normocytic"},"content":{"rendered":"\n<title>Anaemia-normocytic<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Definition: <\/h4>\n\n\n\n<p>Haemoglobin below the normal range associated with a normal MCV<\/p>\n\n\n\n<p>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 \u22643.0 g\/l.&nbsp; This is caused by chronic infective or inflammatory disorders.<\/p>\n\n\n\n<p>*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.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 31-07-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients whose anaemia remains unexplained following the recommended primary care investigations or if unresponsive to haematinic replacement<\/li>\n\n\n\n<li>Anaemia with increased reticulocyte count<\/li>\n\n\n\n<li>Anaemia where blood film suggests myelodysplasia (MDS)<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anaemia due to haematinic deficiency if responsive to appropriate replacement<\/li>\n\n\n\n<li>For proven anaemia of chronic disorders (see definition above) &#8211; investigate for underlying cause based on patient\u2019s symptoms and clinical findings.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI gateway to the Department of Haematology at WGH, St Johns or RIE.<\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Primary care investigations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Blood film<\/li>\n\n\n\n<li>U&amp;Es and LFTs<\/li>\n\n\n\n<li>Thyroid function tests<\/li>\n\n\n\n<li>B12 and folate. Treat if deficiency is detected<\/li>\n\n\n\n<li>Ferritin. Treat if deficiency is detected and consult separate Anaemia due to iron deficiency GP Referral Guideline for further management<\/li>\n\n\n\n<li>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)<\/li>\n\n\n\n<li>If serum iron is low&nbsp;and&nbsp;transferrin \u22653.0 g\/l on a fasting sample, this is diagnostic of iron deficiency \u2013 treat and consult Anaemia due to iron deficiency GP Referral Guideline for further management<\/li>\n\n\n\n<li>Reticulocyte count.<\/li>\n\n\n\n<li>Immunoglobulins and serum protein electrophoresis<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\"><\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Anaemia-normocytic 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 &le;3.0 g\/l.&nbsp; This is caused by chronic<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":15978,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[244],"class_list":["post-3701","page","type-page","status-publish","hentry","category-anaemianormocytic"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/anaemia\/anaemianormocytic\/\" rel=\"tag\">Anaemia-normocytic<\/a>","rttpg_excerpt":"Anaemia-normocytic 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 &le;3.0 g\/l.&nbsp; This is caused by chronic","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3701","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3701"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3701\/revisions"}],"predecessor-version":[{"id":16147,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3701\/revisions\/16147"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15978"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3701"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3701"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}