Which of the following is NOT a hypoproliferative normocytic anemia?

Myelodysplastic syndrome is indeed characterized by ineffective hematopoiesis and can lead to a hypoproliferative normocytic anemia. However, it is important to note that myelodysplastic syndromes, which are a group of disorders caused by poorly formed or dysfunctional blood cells, can cause a range of anemias, but typically they are classified as either hypoproliferative (like in the case of low erythropoiesis) or hyperproliferative with dysplastic features.

On the other hand, multiple myeloma, anemia of chronic disease, and renal failure frequently lead to hypoproliferative normocytic anemia. In multiple myeloma, the increased levels of monoclonal protein can lead to anemia via multiple mechanisms, including suppression of normal hematopoiesis. Anemia of chronic disease is commonly associated with underlying chronic inflammatory states that affect iron metabolism and reduce erythropoietin production, leading to normocytic anemia with low to normal reticulocyte counts. Renal failure results in decreased erythropoietin production, leading to reduced red blood cell production, contributing to hypoproliferative normocytic anemia.

Considering these distinctions, myelodysplastic syndrome is