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Normocytic indices occur in anemias resulting from deficient (EPO) or inadequate response to it (hypoproliferative anemias).Hemorrhage, before iron deficiency develops, usually results in normocytic and normochromic anemia unless the number of large reticulocytes is excessive.The term hypochromia refers to RBC populations in which MCH is The RBC indices can help indicate the mechanism of anemia and narrow the number of possible causes.Microcytic indices occur with altered heme or globin synthesis.

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Acute bleeding may briefly produce macrocytic indices because of the release of large young reticulocytes.Rarely, high-output heart failure develops as a compensatory response to anemia-induced tissue hypoxia.