The two most common causes are Hypoproliferation due to a deficiency of or inadequate response to erythropoietin (EPO) due to inflammation or renal disease The anemia of chronic disease or inflammation (although, if severe, can be microcytic) Acquired primary bone marrow disorders such as aplastic anemia, pure red cell aplasia, and myelodysplastic syndrome (MDS) can also manifest with a normocytic anemia.