A patient with anemia is found to have a low reticulocyte production index (RPI) and a normocytic anemia. Which of the following underlying conditions is most likely responsible for this presentation?

A Chronic kidney disease with decreased erythropoietin production ✓
B Hypothyroidism with decreased metabolic rate
C Chronic inflammation with increased hepcidin production
D Bone marrow fibrosis with decreased erythropoiesis

Explanation

A low RPI indicates inadequate erythropoiesis, and normocytic anemia suggests a problem with red blood cell production rather than destruction or loss. Chronic kidney disease is a common cause of normocytic anemia due to decreased erythropoietin production, which stimulates erythropoiesis.

Source

UpToDate clinical decision support resource
Hematology Hematology: Anemia Hematology: Anemia Medium MEDICAL Confidence: high