From the Guidelines
In a 64-year-old female with normocytic anemia, it is crucial to monitor a comprehensive set of parameters to identify the underlying cause and guide treatment, including complete blood count (CBC), iron studies, vitamin B12 and folate levels, renal function tests, inflammatory markers, reticulocyte count, and screening for occult blood loss and thyroid function. The patient's laboratory results, such as RBC 5.49, MCV 78.3, MCH 24.8, MCHC 31.6, and RDW 15.3, indicate normocytic anemia, which can be caused by various factors including iron deficiency, vitamin B12 or folate deficiency, chronic kidney disease, anemia of chronic disease, or blood loss 1.
Key parameters to monitor include:
- Complete blood count (CBC) to track hemoglobin, hematocrit, and red blood cell indices
- Iron studies, including serum iron, ferritin, total iron binding capacity (TIBC), and transferrin saturation, to rule out iron deficiency
- Vitamin B12 and folate levels to exclude deficiencies that can initially present as normocytic before becoming macrocytic
- Renal function tests, such as creatinine and BUN, to assess for chronic kidney disease, a common cause of normocytic anemia in older adults 1
- Inflammatory markers, like CRP and ESR, to identify anemia of chronic disease
- Reticulocyte count to provide information about bone marrow response
- Screening for occult blood loss through fecal occult blood testing and possibly endoscopic evaluation, as gastrointestinal malignancies become more common with age and can present with normocytic anemia
- Thyroid function tests, as hypothyroidism can contribute to anemia 1
This comprehensive monitoring approach is necessary because normocytic anemia in older adults often has multifactorial causes, requiring thorough investigation to identify the underlying etiology and guide appropriate treatment.
From the Research
Monitoring Parameters for Normocytic Anemia
Given the patient's age and laboratory results, the following parameters should be monitored:
- Hemoglobin levels to assess the severity of anemia 2, 3
- Mean corpuscular volume (MCV) to differentiate between microcytic, normocytic, and macrocytic anemia 3, 4
- Reticulocyte count to evaluate bone marrow response to anemia 5
- Iron profile, vitamin B12, and folic acid levels to identify potential underlying causes of anemia 2, 4, 6
- Renal function tests to rule out chronic renal disease as a cause of anemia 6
- Inflammatory markers to assess for anemia of chronic inflammation 6
Potential Underlying Causes
The patient's anemia may be due to various causes, including:
- Nutritional deficiencies (iron, vitamin B12, or folate deficiency) 2, 4, 6
- Anemia of chronic disease (e.g., chronic renal disease, rheumatoid arthritis) 2, 6
- Unexplained anemia, which may be related to aging or other underlying conditions 2, 6
Laboratory Tests
Regular laboratory tests should be performed to monitor the patient's condition, including: