There are three main causes behind the underproduction of red blood cells. ESA erythropoietin deficiency results in the failure of stimulus, further contributing to chronic kidney diseases. Lack of essential minerals and vitamins such as vitamin B12, iron, or even folate in the body results in ineffective erythropoiesis such as iron-deficient erythropoiesis.Failure of the bone marrow contributes to ineffective bone marrow erythropoiesis.