Differential Diagnosis for Mild Elevation in RBC, HCT, HGB, with Mild Decrease in Folate
- Single Most Likely Diagnosis
- Dehydration: This is the most likely diagnosis as dehydration can cause a relative increase in RBC, HCT, and HGB due to decreased plasma volume, and mild folate deficiency can be seen due to inadequate dietary intake or increased demand.
- Other Likely Diagnoses
- Diuretic use: Long-term use of diuretics can lead to dehydration and subsequent elevation in RBC, HCT, and HGB, and folate deficiency can occur due to increased urinary excretion.
- High-altitude exposure: Acclimatization to high altitudes can cause an increase in RBC, HCT, and HGB due to hypoxia-induced erythropoiesis, and folate deficiency can be seen due to increased demand.
- Smoking: Smoking can cause an increase in RBC, HCT, and HGB due to chronic hypoxia and increased erythropoietin production, and folate deficiency can occur due to increased oxidative stress.
- Do Not Miss Diagnoses
- Polycythemia vera: A myeloproliferative disorder that can cause an increase in RBC, HCT, and HGB, and folate deficiency can occur due to increased cell turnover.
- Renal cell carcinoma: Some renal cell carcinomas can produce erythropoietin, leading to an increase in RBC, HCT, and HGB, and folate deficiency can be seen due to increased demand.
- Rare Diagnoses
- Erythrocytosis due to testicular tumors: Some testicular tumors can produce erythropoietin or other substances that stimulate erythropoiesis, leading to an increase in RBC, HCT, and HGB, and folate deficiency can occur due to increased demand.
- Congenital erythrocytosis: A rare genetic disorder that can cause an increase in RBC, HCT, and HGB, and folate deficiency can be seen due to increased cell turnover.