Anaemia characterised by normal-sized red blood cells


  • Acute blood loss
  • Haemolysis (destruction of red cells), e.g., auto-immune disorder, hypersplenism, haemoglobin abnormalities
    (sickle cell disease, thalassemia), drugs (sulphonamides, dapsone, primaquine)
  • Decreased reticulocytosis (formation of new blood cells), e.g. chronic kidney disease

    Clinical features

  • General features of anaemia


  • Evidence of haemolysis
  • Full blood count smear: spherocytes
  • HIV serology



  • Identify and treat cause of anaemia

Medicine treatment

  • DO NOT treat with iron, folic acid or vitamin B12 unless there is clear documented deficiency
  • Treat all patients with folic acid 5 mg daily in haemolytic anaemia
  • Refer to hospital for further management

Prevention/Health Education for Anaemia

Educate the public about:

  • The life long effects of anaemia on health, and cognitive development
  • Dietary measures: encourage exclusive breastfeeding for the first 6 months. Encourage the use of iron-containing weaning locally available foods (red meat, beans, peas, dark leafy vegetables)
  • Hygiene: avoid walking barefeet to avoid hook worm infestation, use of pit latrines for faecal disposal, and
    practice good hand washing habits
  • Medical: encourage periodic screening for children and pregnant mothers, and presumptive iron therapy for either groups in cases of anaemia.
  • Routine iron supplementation for all pregnant mothers
  • Early treatment of malaria, helminthic infections, etc