Differential Diagnosis for Normocytic, Normochromic Anemia with Slightly Low Hgb

• Single Most Likely Diagnosis
  • Anemia of Chronic Disease (ACD): This is often the most common cause of normocytic, normochromic anemia. It occurs in the context of chronic infections, inflammation, or malignancy, leading to a decrease in erythropoietin production or response, and thus a reduction in red blood cell production.
• Other Likely Diagnoses
  • Acute Blood Loss: Although the hemoglobin (Hgb) level might not be drastically low, acute blood loss can initially present with normocytic, normochromic anemia before the body has a chance to compensate and potentially lead to iron deficiency anemia if the loss is significant and not promptly addressed.
  • Hemodilution: This can occur due to fluid overload, such as in heart failure or due to excessive IV fluid administration, diluting the concentration of red blood cells and thus lowering the Hgb level.
  • Early Iron Deficiency Anemia: Before iron stores are completely depleted and the anemia becomes microcytic, iron deficiency can present with normocytic, normochromic indices.
• Do Not Miss Diagnoses
  • Aplastic Anemia: A rare but serious condition where the bone marrow fails to produce blood cells. It can present with normocytic, normochromic anemia and requires prompt diagnosis and treatment to prevent severe complications.
  • Myelodysplastic Syndromes (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells, which can lead to anemia. Early detection is crucial for management and potential cure.
  • Leukemia or Lymphoma: Although these conditions often present with other cytopenias or abnormalities, in early stages, they might only manifest with anemia.
• Rare Diagnoses
  • Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency, which can cause normocytic, normochromic anemia in its early stages before progressing to megaloblastic anemia.
  • Chronic Kidney Disease: Can lead to normocytic, normochromic anemia due to decreased erythropoietin production by the kidneys.
  • Hypothyroidism: Although less common, severe hypothyroidism can lead to normocytic, normochromic anemia due to decreased metabolism and erythropoiesis.
  • Endocrine Disorders: Such as adrenal insufficiency or hypopituitarism, which can affect erythropoiesis and lead to anemia.