A precise cause for normocytic anemia can be determined through applied pathophysiology. Examination of the peripheral blood smear may yield evidence of renal disease, liver disease, hemolysis or megaloblastic anemia. A reticulocyte count is performed next; then the creatinine clearance is determined. Bone marrow aspiration with iron stain should further narrow the cause. Physical examination and family history remain important in determining the etiology of normocytic anemia.