Anemias associated with normocytic and normochromic red cells and an inappropriately low reticulocyte response (reticulocyte index <–2.5) are hypoproliferative anemias. This category includes early iron deficiency (before hypochromic microcytic red cells develop), acute and chronic inflammation (including many malignancies), renal dis- ease, hypometabolic states such as protein malnutrition and endocrine deficiencies, and anemias from marrow damage.