From the Guidelines
The patient's blood smear results are most consistent with anemia of chronic disease, which is characterized by a normocytic anemia with inappropriately normal reticulocytes, suggesting a problem with bone marrow production rather than blood loss or destruction. The presence of a mild absolute monocytosis and neutrophils with toxic granulations further supports the presence of an underlying inflammatory condition 1. According to the European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases, normocytic anemia with normal or low reticulocytes can be caused by anaemia of chronic disease, among other conditions 1.
Key points to consider in this patient's evaluation include:
- The anemia is normocytic, which helps to narrow down the differential diagnosis
- The reticulocyte count is normal but should be elevated in response to anemia, indicating a problem with bone marrow production
- The presence of toxic granulations in neutrophils and a mild absolute monocytosis suggests an underlying inflammatory condition
- Iron studies and measurement of inflammation markers like CRP or ESR may be helpful in further evaluation
Given the likely diagnosis of anemia of chronic disease, treatment should focus on addressing the underlying inflammatory condition rather than iron supplementation, as iron utilization is often impaired in this condition 1. If the anemia is significant, erythropoiesis-stimulating agents might be considered after addressing the primary disorder. Further evaluation and management should be guided by the underlying cause of the anemia and the patient's overall clinical condition.
From the Research
Anemia Classification
- The patient's blood smear indicates a mild normocytic anemia, which is characterized by a mean corpuscular volume (MCV) of 80 to 100 mcm3 2.
- Normocytic anemia has a broad differential diagnosis, including nutritional deficiencies, blood loss, renal disease, malignancy, rheumatologic disorders, endocrine disorders, and other systemic diseases 3.
Reticulocyte Count
- The patient's reticulocyte count is normal, but inappropriately normal given the presence of anemia, suggesting a possible bone marrow disorder or aplastic anemia 2.
- A low reticulocyte count in the presence of anemia can indicate aplasia or a bone marrow disorder, while an elevated reticulocyte count can indicate blood loss or hemolysis 4.
Leukocyte and Platelet Count
- The patient's leukocyte count is normal, with a mild absolute monocytosis, and leukocyte morphology shows slight cytoplasmic toxic granulations in a few neutrophils 3.
- The platelet count is normal, with no significant morphological abnormalities, and only a few ovalcytes, elliptical, and burr cells are noted.
Possible Causes
- The patient's anemia could be caused by various factors, including anemia of inflammation, hemolytic anemia, anemia of chronic kidney disease, acute blood loss anemia, or aplastic anemia 2.
- Further evaluation, including iron studies, vitamin B12 and folate levels, and thyroid function testing, may be necessary to determine the underlying cause of the anemia 3, 4, 5, 6.