Causes of anemia in adults

RBC size/ MCV	Reticulocyte count
RBC size/ MCV	Low or normal*	Increased
Microcytic MCV <80 fL	Iron deficiency (late) Anemia of chronic disease/inflammation Sideroblastic anemias	Thalassemia Hemolysis^¶
Normocytic MCV 80 to 100 fL	Bleeding (acute) Iron deficiency (early) Anemia of chronic disease/inflammation Bone marrow suppression (cancer, aplastic anemia, infection) Chronic renal insufficiency Hypothyroidism Hypopituitarism Excess alcohol Copper deficiency/zinc poisoning	Bleeding (with bone marrow recovery) Hemolysis^¶ Bone marrow recovery (eg, after infection, vitamin B12 or folate replacement, and/or iron replacement)
Macrocytic MCV >100 fL	Vitamin B12 or folate deficiency Excess alcohol Myelodysplastic syndrome Liver disease Hypothyroidism HIV infection Medications that interfere with nuclear maturation (hydroxyurea, methotrexate, some chemotherapy agents)	Hemolysis^¶ Bone marrow recovery (eg, after infection, vitamin B12 or folate replacement, and/or iron replacement)

Review of the RBC morphology is critical to the assessment of many anemias. Refer to UpToDate for features of specific causes of anemia and discussions of the approach to the patient evaluation.

RBC: red blood cell; MCV: mean corpuscular volume; fL: femtoliters.
* A reticulocyte count in the normal range (especially the lower end of the normal range) may be inappropriately low in an individual with significant anemia and may suggest a component of impaired bone marrow function.
¶ Hemolysis typically is associated with a normal or high MCV. Microcytosis is generally restricted to types of hemolysis with RBC fragmentation. Hemolysis is typically associated with some degree of macrocytosis because reticulocytes are larger than mature RBCs.

Graphic 122070 Version 4.0

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Causes of anemia in adults