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Anemias due to decreased red cell production

Stanley L Schrier, MD
Section Editor
William C Mentzer, MD
Deputy Editor
Jennifer S Tirnauer, MD


A variety of disorders are associated with anemia due to decreased red cell production (ie, hypoproliferative anemia). This situation is simplistically identified by the finding of a low corrected absolute reticulocyte count (reticulocytopenia). Thus, if a normal corrected absolute reticulocyte count is 25,000 to 75,000/microL (1.0 ± 0.5 percent of the five million red cells/microL), a corrected absolute reticulocyte count below 25,000/microL indicates poor red cell production. (See "Approach to the adult patient with anemia", section on 'Reticulocyte count'.)

There are, however, several important caveats to the interpretation of the reticulocyte count:

A reticulocyte count of 27,000/microL (ie, at the lower limit of normal) in an anemic patient does not mean that production is normal for that patient.

Suppose a patient is losing blood due to hemolysis or blood loss at a rate five times normal and the reticulocyte increase is only three times normal. In this setting, impaired production is contributing to the anemia even though the corrected absolute reticulocyte count is three times normal.

The differential diagnosis of a hypoproliferative anemia can often be narrowed by identification of one of the six specific presenting patterns outlined below. The differential diagnosis of a hypoproliferative anemia with microcytosis, which is most often due to iron deficiency, is discussed separately. (See "Causes and diagnosis of iron deficiency and iron deficiency anemia in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Nov 11, 2013.
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