Which of the following anemias is classified as normocytic and hyperproliferative?

Question

Accepted Answer

C. Acute hemorrhage. ## Normocytic Hyperproliferative Anemias

**Key Point:** Normocytic anemias with elevated reticulocyte counts (hyperproliferative) indicate appropriate bone marrow response to RBC loss or destruction. The marrow is functioning normally but working overtime.

### Classification of Normocytic Anemias

| Anemia Type | Reticulocyte Count | Mechanism | Examples |
| --- | --- | --- | --- |
| **Hyperproliferative (High Retic)** | >2% | Appropriate marrow response to loss/destruction | Acute hemorrhage, hemolytic anemia, hemoglobinopathies |
| **Hypoproliferative (Low Retic)** | <2% | Inadequate marrow response despite anemia | Aplastic anemia, chronic kidney disease, anemia of chronic disease (late), mixed deficiencies |

**High-Yield:** The reticulocyte count is the key discriminator within the normocytic category. A high reticulocyte count indicates the marrow is responding appropriately to RBC loss or destruction; a low count suggests a primary marrow problem.

### Acute Hemorrhage: The Prototype

**Clinical Pearl:** Acute hemorrhage is the classic normocytic, hyperproliferative anemia:
- **MCV:** Normal (80–100 fL) — RBCs are normal size
- **Reticulocyte count:** Elevated (>2%, often >5%) within 3–5 days
- **Mechanism:** Bone marrow responds appropriately to acute blood loss by releasing immature RBCs
- **Timeline:** Reticulocytosis peaks at 5–7 days post-hemorrhage

### Why Other Options Are Wrong

- **Vitamin B12 deficiency:** Macrocytic (MCV >100 fL) due to impaired DNA synthesis
- **Chronic kidney disease:** Normocytic but **hypoproliferative** (low reticulocytes) due to erythropoietin deficiency
- **Folate deficiency:** Macrocytic (MCV >100 fL) due to impaired DNA synthesis

Answer

A. Folate deficiency

Answer

B. Chronic kidney disease

Answer

D. Vitamin B12 deficiency

Which of the following anemias is classified as normocytic and hyperproliferative?

Explanation

Normocytic Hyperproliferative Anemias

Classification of Normocytic Anemias

Acute Hemorrhage: The Prototype

Why Other Options Are Wrong

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Anemia Type	Reticulocyte Count	Mechanism	Examples
Hyperproliferative (High Retic)	>2%	Appropriate marrow response to loss/destruction	Acute hemorrhage, hemolytic anemia, hemoglobinopathies
Hypoproliferative (Low Retic)	<2%	Inadequate marrow response despite anemia	Aplastic anemia, chronic kidney disease, anemia of chronic disease (late), mixed deficiencies