Descriptive Study of the Spectrum of Disorders Presenting as Normocytic Normochromic Anaemia from a Tertiary Care Setting at Ernakulam, Kerala, India

Introduction: Anaemia is a common problem discovered on routine laboratory tests. Based on red cell morphology, anaemia can be classified as microcytic hypochromic, macrocytic and Normocytic Normochromic Anaemia (NNA). Anaemia is not a diagnosis in itself, but merely an objective sign of underlying disease. The correct treatment requires an understanding of the pathogenesis of the condition. Varied number of clinical disorders manifests as NNA and pose a great challenge to the clinician. Aim: To identify the spectrum of disorders presenting as NNA and to grade anaemia across age and sex of individual using World Health Organisation (WHO) criteria. Materials and Methods: This prospective descriptive study was conducted in a tertiary care teaching hospital, Ernakulam, Kerala, India during one year period of February 2017-January 2018. Total of 514 patients meeting the inclusion criteria were recruited for the study. After taking detailed history and clinical examination, investigations were done including Complete Blood Count (CBC), peripheral smear preparation, reticulocyte count, Renal Function Tests (RFT), Liver Function Tests (LFT) and if necessary, bone marrow study and radiological studies were done. The data obtained was statistically analysed using Microsoft Excel 365. Descriptive statistics viz., number of cases, percentage, concomitant involvement with other disorders, differential involvement with various age groups, male:female ratio, and grade of anaemia were utilised to describe the spectrum of disorders presenting as NNA. Results: Of the 514 patients, 433 were adults and 81 were in paediatric age group. The average age in adult males were 58 years and in females 57 years with Haemoglobin (Hb) being 9.04 g/dL and 8.99 g/dL, respectively. Paediatric population had an average Hb of 10.18 g/dL. A total of 106 conditions were seen among the 514 patients. The disease conditions were further categorised into 10 subtypes. Type 2 Diabetes Mellitus (T2DM) constituted single most common associated disorder (112 cases) seen along NNA followed by Coronary Artery Disease (CAD) (74 cases). Idiopathic cases constituted 79 cases. Conclusion: The NNA constituted 25% of the cases presented to the laboratory during the study period. T2DM was associated with NNA along with CAD. An understanding of the categories of anaemia along with a diagnostic protocol will go a long way in better management of the patient.