Differential Diagnosis for a 70-year-old Lady with Severe Anemia
Single most likely diagnosis
- Iron deficiency anemia due to chronic disease: The patient's severe anemia (Hb dropped from 8.5g/dl to 5.5g/dl in 2 months) without a history of bleeding, along with the presence of small white patches on the shin (possibly indicative of skin lesions or poor wound healing), suggests a chronic condition affecting iron metabolism or absorption. Conditions like chronic kidney disease, chronic infections, or malignancies can lead to iron deficiency anemia.
Other Likely diagnoses
- Vitamin deficiency anemia (B12 or folate deficiency): Given the patient's age and the rapid progression of anemia, a deficiency in vitamin B12 or folate could be a contributing factor. These deficiencies can lead to megaloblastic anemia and are common in the elderly due to dietary deficiencies, malabsorption, or increased demand.
- Anemia of chronic disease: This condition is characterized by a decrease in the production of red blood cells due to chronic inflammation. The presence of small white patches on the skin could be indicative of an underlying inflammatory or infectious process.
- Myelodysplastic syndrome (MDS): Although less common, MDS should be considered in the differential diagnosis, especially given the patient's age and the severity of anemia. MDS can lead to ineffective erythropoiesis and result in severe anemia.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Gastrointestinal malignancy: Although there's no history of bleeding, a gastrointestinal malignancy could be causing chronic blood loss leading to iron deficiency anemia. It's crucial to rule out such a condition due to its severe implications.
- Hematological malignancy: Conditions like leukemia or lymphoma can cause severe anemia and should not be overlooked, despite their lower likelihood.
Rare diagnoses
- Sickle cell disease with superimposed iron deficiency: Although rare in a 70-year-old, if the patient has sickle cell trait or disease, superimposed iron deficiency could exacerbate anemia.
- Pernicious anemia: An autoimmune condition leading to vitamin B12 deficiency, which is rare but should be considered if other causes are ruled out.
- Paroxysmal nocturnal hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for blood clot formation.