Differential Diagnosis for 73-year-old Female with Weakness, Lightheadedness, and Low BP
- Single Most Likely Diagnosis
- Anemia of Chronic Disease (ACD) or Anemia of Chronic Kidney Disease (CKD): The patient's low hemoglobin, hematocrit, and GFR suggest chronic kidney disease, which can lead to anemia. The recent post-operative changes in the lumbar spine may also contribute to anemia due to blood loss or inflammation.
- Other Likely Diagnoses
- Dehydration: The patient's low BP, elevated BUN, and creatinine levels suggest dehydration, which can exacerbate anemia and electrolyte imbalances.
- Adrenal Insufficiency: The patient's low glucose, low BP, and electrolyte imbalances (low CO2) may indicate adrenal insufficiency, which can cause anemia and weakness.
- Gastrointestinal Blood Loss: Although the CT scan did not show an acute GI bleed, the patient's anemia and low hemoglobin suggest possible chronic blood loss, which may not be visible on imaging.
- Do Not Miss Diagnoses
- Sepsis: The patient's low WBC, low lymphocytes, and elevated AST-SGOT may indicate sepsis, which can cause anemia, organ dysfunction, and death if not promptly treated.
- Hemorrhage: Although the CT scan did not show an acute bleed, the patient's anemia and low hemoglobin suggest possible internal bleeding, which can be life-threatening if not addressed.
- Addisonian Crisis: The patient's low glucose, low BP, and electrolyte imbalances may indicate an Addisonian crisis, which requires immediate treatment with corticosteroids.
- Rare Diagnoses
- Myelodysplastic Syndrome (MDS): The patient's low WBC, RBC, and platelet counts may suggest MDS, a rare bone marrow disorder that can cause anemia and other cytopenias.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): The patient's anemia, low hemoglobin, and elevated AST-SGOT may indicate PNH, a rare disorder that can cause hemolytic anemia and thrombosis.
- Hemophagocytic Lymphohistiocytosis (HLH): The patient's low WBC, low lymphocytes, and elevated AST-SGOT may suggest HLH, a rare disorder that can cause anemia, organ dysfunction, and death if not promptly treated.