If you are concerned about how anaemia impacts your heart, you have come to the correct place. I've helped many individuals grasp the link between blood health and heart disease, and I can certainly explain it to you as well.

Normocytic Anaemia means you have a small number of red blood cells in your bloodstream, but the haemoglobin is in the right quantity. If you are concerned about how this condition occurs and how it is affecting your heart, and also how to avoid it?. Let's dive deeper to look at the root cause. 

Introduction

If you have a very low amount of red blood cells (RBCs) than normal, but they are normal in size, meaning they are not too small or too large and contain a normal quantity of haemoglobin per cell, you may have normocytic anaemia. Normocytic anaemia may be termed by a treating physician as a medical problem or as a sign of another condition. Sometimes you may have normocytic anaemia due to a hereditary disorder. Normocytic anaemia is most commonly caused by a hidden chronic disease. By treating this underlying cause, your doctor may be able to treat normocytic anaemia.¹

So you must be thinking what this haemoglobin is and why it is so important for our body. In humans, haemoglobin (Hgb or Hb) plays a major role in the transport of oxygen. Only about 2% of the oxygen transported by RBCs is directly dissolved in your bloodstream; the other 98% is bound to haemoglobin.² Haemoglobin is a protein in nature. Haemoglobin carries oxygen, which is present in your red blood cells. Each red blood cell tends to carry 4 molecules of oxygen. Red blood cells deliver oxygen to your cells and tissues, allowing them to operate normally. When red blood cells reach the tissues that demand oxygen, haemoglobin releases oxygen, which spreads into the cells and is used to generate energy.³ Consider this: if your circulation has a low number of RBCs, even if they are normal size, your heart muscles will pump blood more quickly to satisfy the oxygen demands of your other tissues and organs. Low haemoglobin causes the heart to work harder, straining the heart muscles and raising the risk of cardiac problems.

Common causes of normocytic anaemia

Now that you know what normocytic anaemia is, let's dive into what causes this condition. The following are some of the causes that could lead to normocytic anaemia.

• You're losing blood. Blood loss can occur due to a variety of factors, including injury or a medical condition that causes internal bleeding. Heavy periods can cause normocytic anaemia
• You are at risk of developing normocytic anaemia if you have a medical condition that inhibits your body's ability to produce enough red blood cells
• Or, you have a medical issue that causes your red blood cells to break down more quickly than usual. This type of condition is called haemolysis⁴

How does normocytic anaemia affect the heart?

Low oxygen supply to the heart can be a major issue for heart health. Low oxygen supply can put a load on the heart to pump blood faster so that the oxygen demand is fulfilled by all the organs. While some of your cells can adjust to temporary drops, prolonged hypoxia can lead to organ stress and damage. Heart and brain damage are dangerous as they can lead to death.

How does low haemoglobin affect the heart?

Left ventricular hypertrophy

To withstand higher pressure, the left side of the heart hardens, making it more difficult to relax and fill (diastolic dysfunction). The thicker cardiac muscle and higher pressure reduce blood flow to the heart itself. This can eventually affect the heart's capacity to pump blood (systolic dysfunction).⁵

Heart failure

Low haemoglobin (anaemia) and heart failure frequently occur simultaneously. Just like the common kind in normocytic anaemia, which occurs when red blood cells are normal in size but insufficient in number. The greater the anaemia, the more likely it is to exacerbate heart failure and negatively impact health.

Arrhythmias

Heart Arrhythmias are abnormal or irregular heart rhythms generated by changes in electrical impulses. The heart may beat too fast or too sluggish. Alternatively, the heart rate pattern might be unpredictable. It can be detected if you have normocytic anaemia.⁴

Risk factors and who is most affected?

Normocytic anaemia is more going to affect those persons who have other health problems, which can be seen most in elderly people. It is most commonly seen in those with heart problems, kidney disease, or diabetes. These long-term disorders can stop the body from making enough healthy red blood cells, even if the cells are normal in size. Older persons and those with heart failure are more likely to develop this type of anaemia, which may negatively impact their health by making their bodies weak, causing fatigue and developing heart stress.

Signs and symptoms to watch out for

So if you think you may have this type of anaemia. You should watch out for the Signs and symptoms. It is important to note that normocytic anaemia takes time to develop. While some symptoms might not be present at first. Some of the common symptoms to look out for are:

• Fatigue
• Dizziness or light-headedness
• Breathlessness, shortness of breath, difficulty breathing.
• Exercise intolerance
• Generalized weakness
• Palpitation
• Headaches
• Pale skin and lips
• Muscle Weakness³

Diagnosis and testing

You should consult your doctor if you have any of the above symptoms. Your healthcare consultant might run some tests, which are as follows.

CBC and haemoglobin levels

In normocytic anaemia, for diagnosis, a CBC (Complete Blood Count) will reveal red blood cells of normal size (normocytic), but haemoglobin levels will be below normal for the patient's gender and age. Anaemia is defined as haemoglobin levels less than 13 g/dL in men and less than 12 g/dL in premenopausal women.³

Reticulocyte count, kidney function tests

What is the reticulocyte count? A reticulocyte count determines the quantity of immature red blood cells (reticulocytes) in your bone marrow. So the doctor will perform reticulocytes to check whether your bone marrow is creating enough healthy red blood cells.⁶

Peripheral blood smear

This test is used by healthcare providers to diagnose the underlying cause of normocytic anaemia. It is important in diagnostics and used to visualise the morphology of the red blood cells.⁶

What are the treatment approaches?

Treating the underlying cause

Doctors first attempt to resolve the underlying issue that is producing the low haemoglobin. For example, if it's caused by renal disease or a long-term illness, they'll focus on treating the underlying ailment to boost red blood cell counts.

• Iron, B12, or folate supplementation if needed. If the body is missing important nutrients like iron, vitamin B12, or folate, then a supplement may be prescribed for treatment purposes⁷
• Erythropoietin therapy in chronic kidney disease. People with kidney illness may receive injections of the hormone erythropoietin. This hormone tells the bone marrow to produce more red blood cells, which increases haemoglobin levels
• Managing cardiovascular risks. Doctors also address conditions such as high blood pressure, diabetes, and cholesterol. Managing these risks prevents the heart from being further injured as a result of the additional stress generated by low haemoglobin¹

Preventing heart complications

If you have normocytic anaemia or you want to prevent the risk of developing it you should always check for any underlying issues. Since anaemia reduces the oxygen delivery to the heart it can strain the heart and lead to heart problems as discussed before. You can build strategies which include:

• Keeping a healthy diet, eating green vegetables and leaves to support iron levels (Spinach, Beetroot, etc. or having iron supplements)
• Taking your B12 supplement daily if you have a confirmed deficiency
• Monitor and maintain an adequate amount of haemoglobin
• Managing Iron deficiency if you have one
• Regular Cardiovascular monitoring
• Lifestyle changes such as good night sleep, not smoking, avoiding alcohol, managing stress and Blood pressure

Summary

Normocytic anaemia is more than fatigue for your heart. And you must remove this fatigue from your heart to avoid further complications that occur, such as heartbeat fluctuations, palpitations and in most elderly people, they are at risk of heart failure. Just like we need oxygen to survive, our heart and organs need the same. Follow a healthy lifestyle, take your medication regularly if you have any of the underlying illnesses that might lead to anaemia, and regularly consult a doctor to keep a check on your haemoglobin levels.