From the Guidelines
Based on the provided values (hemoglobin 11.1 g/dL, hematocrit 35.6%, and MCV 87.3 fL), this appears to be a mild normocytic anemia, as the MCV is within normal limits (80-100 fL), indicating normocytic red blood cells 1. The hemoglobin and hematocrit are slightly below normal ranges, which is consistent with anemia. To determine the underlying cause, I recommend ordering the following tests:
- Complete blood count with differential
- Reticulocyte count
- Iron studies (including serum iron, total iron binding capacity, ferritin) to confirm iron deficiency, as serum ferritin is the single most useful marker of iron deficiency anemia 1
- Vitamin B12 and folate levels
- Peripheral blood smear Additionally, inflammatory markers like C-reactive protein and erythrocyte sedimentation rate would be helpful, as this pattern could represent anemia of chronic disease or early iron deficiency. Kidney function tests should also be considered to rule out anemia of chronic kidney disease. Some possible causes of this mild normocytic anemia include:
- Early iron deficiency
- Chronic disease
- Hemolysis
- Blood loss These tests will help narrow down the specific etiology and guide appropriate treatment, with the goal of improving morbidity, mortality, and quality of life. A good response to iron therapy (Hb rise ≥10 g/L within a 2-week timeframe) in anaemic patients is highly suggestive of absolute iron deficiency, even if the results of iron studies are equivocal 1.
From the Research
Anemia Classification
The patient's hemoglobin level of 11.1 g/dL, hematocrit (Hct) of 35.6%, and mean corpuscular volume (MCV) of 87.3 fL can be used to classify the type of anemia.
- The MCV value of 87.3 fL is within the normal range of 80-100 fL, indicating that the patient has a normocytic anemia 2, 3.
- Normocytic anemia has a broad differential diagnosis, including anemia of inflammation, hemolytic anemia, anemia of chronic kidney disease, acute blood loss anemia, and aplastic anemia 3.
Differential Diagnosis
The differential diagnosis of normocytic anemia includes:
- Anemia of inflammation
- Hemolytic anemia
- Anemia of chronic kidney disease
- Acute blood loss anemia
- Aplastic anemia 3
- Other systemic diseases, such as malignancy, rheumatologic disorders, and endocrine disorders 2
Laboratory Evaluation
The laboratory evaluation of anemia begins with a complete blood count and reticulocyte count 4.
- The patient's laboratory results, including serum iron level, total iron-binding capacity, and serum ferritin level, would be helpful in confirming the diagnosis and guiding further evaluation 4.