Dr Yen Hun Wee
Eastern Health


Title: The Prevalence And Risk Factors Of Normocytic Normochromic Anaemia (NCNCA) In Patients With Type 2 Diabetes Mellitus – Preliminary Results

Authors: Wee Y1, Liew K1, Anpalahan M1,2

Affiliation: 1 Eastern Health, 2 North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Australia.

Abstract Text: 

To determine the prevalence and the potential risk factors of normocytic normochromic anaemia (NCNCA) in patients with type 2 diabetes mellitus (T2DM) and normal serum creatinine.

Preliminary analyses of 6 months data of a large prospective observational study of patients with T2DM seen in a diabetic clinic are presented. Anaemia was defined as a haemoglobin (Hb) < 130g/l for men and 120g/l for women based on the most recently measured Hb.  A normal MCV (83-101 fL) and MCHC (315-360 g/L) were used to define NCNCA. Patients with raised serum creatinine (≥ 110mmols/l for males and ≥ 90mmols/l for females) and chronic inflammatory conditions were excluded.

Of the 138 patients who met the inclusion criteria, 43 (31%) had anaemia: 23 (53%) normocytic normochromic; 13 (30%) microcytic and 1 (2%) macrocytic. The univariate group comparison of patients with NCNCA vs. those who did not have anaemia is shown in table 1. Patients with NCNCA were significantly older and more likely to have an eGFR < 60ml/min/1.73m2 and albuminuria.  The mean estimate of eGFR was also significantly lower in the NCNCA group.  There were no group differences for other clinical variables including comorbidity. After multivariable adjustment, older age (Adjusted odds ratio (OR) 1.36, 95%CI 1.19-4.28), eGFR< 60 ml/min/1.732 (Adjusted OR 2.03, 95%CI 1.10-8.92) and albuminuria (Adjusted OR 2.02, 95% CI 1.03-7.20) still had an independent association with NCNCA. 
Conclusion: NCNCA is the commonest type of anaemia in patients with T2DM and normal serum creatinine. The potential risk factors of NCNCA include older age, eGFR  < 60ml/min/1.732 and albuminuria. The results, however, have to be confirmed in a larger sample.

Table 1. Univariate group comparison of NCNCA with non-anaemic group