Differential Diagnosis for Worsening Fatigue in a Patient with Hemoglobin SS Disease
- Single most likely diagnosis:
- C. Medication adverse effect: The patient has been taking hydroxyurea, which is known to cause bone marrow suppression, leading to a decrease in hemoglobin levels and an increase in mean corpuscular volume (MCV). The decrease in reticulocytes also supports this diagnosis, as hydroxyurea can suppress erythropoiesis.
- Other Likely diagnoses:
- B. Hyperhemolytic crisis: Although the patient has not had any vasoocclusive pain crises, a hyperhemolytic crisis can occur without pain and can lead to a decrease in hemoglobin levels. However, the lack of an increase in reticulocytes and the presence of a decreased reticulocyte count make this diagnosis less likely.
- A. Anemia of inflammation: Chronic inflammation can lead to anemia of inflammation, which can cause a decrease in hemoglobin levels. However, the patient's temperature is normal, and there is no other evidence of inflammation, making this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- E. Viral-induced pure red cell aplasia: This is a rare but potentially life-threatening condition that can cause a severe decrease in red blood cell production. Although it is unlikely, it is essential to consider this diagnosis due to its potential severity.
- F. Vitamin B12 deficiency: A vitamin B12 deficiency can cause a decrease in hemoglobin levels and an increase in MCV. Although the patient is taking folic acid, a vitamin B12 deficiency can still occur, and it is essential to rule out this diagnosis.
- Rare diagnoses:
- D. Myelodysplastic syndrome: This is a rare condition that can cause bone marrow failure, leading to a decrease in hemoglobin levels. However, it is unlikely in a patient with hemoglobin SS disease, and there is no other evidence to support this diagnosis.