Causes and diagnosis of anemia

Causes of anemia

The cause of normochromic normocytic anemia can be:

  • acute blood loss from acute injury (trauma)
  • chronic bleeding
    • a tumor
    • an ulcer
    • hemorrhoids
      or if the menstruation is too heavy or too frequent.

Another reason for anemia can be the reduced production of red blood cells.
A distinction is made between anemia

  • due to iron deficiency (iron deficiency anemia)
  • due to vitamin deficiency (hyperchromic anemia)
  • due to erythropoietin deficiency (= EPO; a protein from kidney and liver that stimulates blood formation)
  • due to infectious-toxic causes.

The so-called sickle cell anemia can also be the cause of anemia. You can find out how dangerous it is and how it is noticeable in our article about Sickle cell disease.

In addition, the anemia caused by the dissolution of the red blood cells (hemolysis) or the accelerated breakdown of the erythrocytes is to be mentioned. Other forms of anemia can be caused by genetic defects.


In the anamnesis (questioning the patient) and the clinical examination, in addition to the questioning and determination of the symptoms, it must also be clarified whether the symptoms occurred suddenly or whether they have developed slowly over a longer period of time.
In the second step there is a Laboratory examination of the blood Information about the composition of the blood.

Are measured thereby Laboratory parameters how:

  • number of red blood cells
  • Concentration of the red blood pigment hemoglobin
  • Reticulocyte count (percentage of young red blood cells)
  • Volume of erythrocytes (MCV = mean corpuscular volume)
  • MCH = mean corpuscular hemoglobin
  • MCHC = mean corpuscular hemoglobin concentration
  • Parameters of iron metabolism such as serum iron (iron bound to transferrin in the blood for transport), and ferritin or hemosiderin (storage proteins for iron), sTfR (soluble transferrin receptor in the blood)
  • Blood platelets (thrombocytes) and white blood cells (leukocytes)

A blood smear on a glass slide under the microscope provides information about the shape and stainability of the erythrocytes.
Further diagnostics are used to differentiate the type of anemia. A puncture can be helpful in assessing production in the bone marrow, i.e. that a sample of bone marrow tissue is taken through a needle and examined. The assessment of iron metabolism and the possibility of hemolysis (dissolution of the blood) must also be clarified.