Knowledge Check

Hypoproliferative anemia is another way of saying anemia with an inappropriate reticulocyte response.

You have a patient with normocytic anemia. The reticulocyte count is appropriately elevated. There is no evidence of acute or chronic blood loss. What lab test(s) is/are reasonable to order next?

a
ALT
ALT is not marker of hemolysis.
b
AST
Correct. AST is a marker of hemolysis.
c
Peripheral smear
Yes! The peripheral smear is KEY in a patient with suspected hemolysis.
d
Direct bilirubin
Indirect bilirubin is a marker of hemolysis, not direct bilirubin.
e
Direct antiglobulin test
This helps to rule in or rule out an immune mechanism for hemolysis.

True or false: anemia secondary to hypothyroidism is always normocytic.

a
True
b
False
It may also present as macrocytic anemia. In one study of 202 patients with hypothyroidism (Q J Med. 1976;45:101-23), 38% had elevated MCV, and 20% of these patients were anemic.

True or false: anemia secondary to liver disease is always normocytic.

a
True
b
False
About 20% of patients with non-alcoholic cirrhosis and 75% of patients with alcoholic cirrhosis have an elevated MCV (for example, see J Lab Clin Med. 2001;138:332-7).

True or false: anemia of inflammation is always normocytic.

a
True
b
False
About 20% of patients with anemia of inflammation have a lower-than-normal MCV.

Can you think of a situation in which a patient has a normocytic anemia (normal mean cell volume) but only a minority of their red blood cells are normocytic?

Answer on next slide

Dimorphic is a term used to describe two circulating red cell populations