What Does a Low Red Blood Count Mean When Iron Levels Are Normal?

A low red blood cell count coupled with normal iron levels may indicate a number of conditions, such cancer and cirrhosis. Another condition, anemia of inflammation and chronic disease (AI/ACD), occurs when blood iron levels are low but iron storage is normal, says the National Hematologic Diseases Information Service.

Most patients who have anemia have both a low red blood cell count and low iron levels. Anemia is a common cause of lower red blood cell levels. Still, patients might see that they have low red blood cells but normal iron levels. Doctors can rule out anemia in this case, but other serious conditions may also cause low red blood cells. These include non-Hodgkin’s lymphoma, hypothyroidism and kidney disease. Certain medications may also lower red blood cell counts temporarily, says Mayo Clinic.

Alternatively, one form of anemia, AI/ACD, involves having a normal to high level of iron stores but low red blood cell counts. Most people with AI/ACD have chronic infections or illnesses, says the NHDIS. With AI/ACD, iron levels show up at a low level because the body fails to utilize the iron stores the way it should. For this reason, most people with low blood cell counts and normal iron levels likely have a condition that is not related to anemia.