Differential Diagnosis for 34 yo Female with Iron Studies

The patient's iron studies and complete blood count (CBC) results indicate iron deficiency anemia, as evidenced by low iron levels, low ferritin, and elevated total iron-binding capacity (TIBC). The following differential diagnosis is organized into categories:

• Single Most Likely Diagnosis

  • Iron Deficiency Anemia: This is the most likely diagnosis given the patient's low iron, low ferritin, and high TIBC levels, which are all characteristic of iron deficiency anemia. The patient's hemoglobin (Hgb) and hematocrit (Hct) are within normal limits, but this could be due to the early stage of the disease or mild anemia.

• Other Likely Diagnoses

  • Anemia of Chronic Disease: Although the patient's iron studies suggest iron deficiency, anemia of chronic disease (ACD) can also present with low iron and ferritin levels. However, ACD typically has a low TIBC, which is not the case here.
  • Thalassemia Trait: The patient's mean corpuscular volume (MCV) is at the lower end of normal, and the mean corpuscular hemoglobin (MCH) is slightly low. Thalassemia trait could be considered, but the iron studies do not support this diagnosis as the primary cause of anemia.
  • Celiac Disease: Celiac disease can cause iron deficiency anemia due to malabsorption. Although the patient's iron studies are consistent with iron deficiency, celiac disease would require further evaluation, such as serologic tests and intestinal biopsy.

• Do Not Miss Diagnoses

  • Gastrointestinal Bleeding: A source of chronic blood loss, such as gastrointestinal bleeding, could be causing the patient's iron deficiency anemia. This diagnosis is critical to rule out, as untreated bleeding can lead to severe anemia and other complications.
  • Malignancy: Certain malignancies, such as colorectal cancer, can cause iron deficiency anemia due to chronic blood loss or malabsorption. Although the patient is relatively young, malignancy should be considered, especially if other risk factors are present.

• Rare Diagnoses

  • Hereditary Sideroblastic Anemia: This rare genetic disorder affects the production of hemoglobin and can cause iron overload or deficiency. However, the patient's iron studies do not suggest iron overload, making this diagnosis less likely.
  • Pyridoxine-Responsive Anemia: This rare condition is caused by a deficiency in vitamin B6 (pyridoxine) and can lead to iron deficiency anemia. However, the patient's iron studies and CBC results do not specifically suggest this diagnosis.