Differential Diagnosis for a 78-year-old Female with Long-term Cortical Steroid Use
Single Most Likely Diagnosis
- Steroid-induced erythrocytosis with macrocytosis: The patient's long-term use of cortical steroids can lead to an increase in red blood cell mass, which may result in an elevated hematocrit. However, in this case, the hematocrit is normal, but the MCV is high, suggesting macrocytosis. The normal hemoglobin and hematocrit levels, combined with the high MCV, support this diagnosis.
Other Likely Diagnoses
- Vitamin B12 or folate deficiency: Although the patient's MCV is high, which can be seen in vitamin B12 or folate deficiency, the normal MCHC and RDW make this diagnosis less likely. However, it is still a possibility, especially in an elderly patient.
- Alcohol-related macrocytosis: The patient's high MCV could be related to alcohol use, but there is no information provided about her alcohol consumption habits.
- Thyroid disorders: Hypothyroidism can cause macrocytosis, but there is no information provided about the patient's thyroid function.
Do Not Miss Diagnoses
- Myelodysplastic syndrome (MDS): Although the patient's RDW is normal, MDS can present with a high MCV and normal or slightly low hemoglobin levels. This diagnosis is critical to consider, especially in an elderly patient, as MDS can progress to acute leukemia.
- Bone marrow failure: The patient's low red blood cell count, despite normal hemoglobin and hematocrit levels, could indicate bone marrow failure. This diagnosis is essential to consider, as it can have significant implications for the patient's health.
Rare Diagnoses
- Paroxysmal nocturnal hemoglobinuria (PNH): This rare disorder can cause macrocytosis, but it is typically associated with other symptoms, such as hemolytic anemia, which are not present in this patient.
- Congenital dyserythropoietic anemia: This rare group of disorders can cause macrocytosis, but they are typically diagnosed at a younger age, and the patient's presentation does not suggest this diagnosis.