Differential Diagnosis for 68 y/o Female with Laboratory Results
The patient's laboratory results show a ferritin level of 33, which is below the normal range for females (typically >50 ng/mL), indicating depleted iron stores. However, the hemoglobin (12.4 g/dL), hematocrit (39.7%), and red blood cell (RBC) count (5.05 million/μL) are within normal limits or slightly elevated, suggesting that despite the low ferritin, the patient is not currently anemic based on these parameters. The mean corpuscular volume (MCV) is 79 fL, mean corpuscular hemoglobin (MCH) is 24.6 pg, and mean corpuscular hemoglobin concentration (MCHC) is 31.2 g/dL, which are within normal limits.
- Single Most Likely Diagnosis
- Iron deficiency without anemia: The patient has low ferritin levels indicating depleted iron stores, but her hemoglobin and hematocrit are within normal limits. This suggests she is at risk of developing iron deficiency anemia but is not anemic at present.
- Other Likely Diagnoses
- Thalassemia trait: Given the patient's MCV is at the lower end of the normal range, thalassemia trait could be considered, especially if there's a family history or ethnic predisposition. However, the MCH and MCHC are within normal limits, which makes this less likely.
- Anisocytosis (variation in RBC size) without a specific underlying cause: This could be due to various factors including but not limited to early iron deficiency, vitamin deficiencies, or other chronic diseases.
- Do Not Miss Diagnoses
- Chronic disease with iron sequestration: Conditions like chronic infections, autoimmune diseases, or malignancies can lead to low ferritin due to inflammation rather than true iron deficiency. It's crucial to investigate for underlying chronic diseases.
- Hemoglobinopathy: Although less likely given the normal MCV, MCH, and MCHC, certain hemoglobinopathies could present with near-normal indices and should be considered, especially with any suggestive family or ethnic history.
- Rare Diagnoses
- Sideroblastic anemia: A group of disorders characterized by the presence of ringed sideroblasts in the bone marrow, which could present with variable degrees of anemia, but the patient's current hemoglobin and hematocrit levels are not suggestive of anemia.
- Other rare genetic disorders affecting iron metabolism or erythropoiesis: These would be considered if common causes are ruled out and there are specific clinical or family history suggestions.