Differential Diagnosis for Anemia

The patient's laboratory results show a hemoglobin (HGB) level of 10.8 g/dL, hematocrit (HCT) of 33.5%, mean corpuscular volume (MCV) of 78.8 fL, mean corpuscular hemoglobin (MCH) of 25.4 pg, iron level of 36.6 μg/dL, total iron-binding capacity (TIBC) of 322.91 μg/dL, and ferritin level of 51.8 ng/mL. Based on these results, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Iron deficiency anemia: The patient has a low iron level (36.6 μg/dL) and a high TIBC (322.91 μg/dL), which are indicative of iron deficiency anemia. The ferritin level is slightly elevated, which may suggest an acute phase response or mixed anemia, but the overall picture leans towards iron deficiency.

• Other Likely Diagnoses

  • Anemia of chronic disease: The slightly elevated ferritin level (51.8 ng/mL) could suggest anemia of chronic disease, especially if there's an underlying inflammatory condition. However, the iron level and TIBC suggest iron deficiency is more prominent.
  • Mixed anemia (iron deficiency and anemia of chronic disease): Given the combination of low iron, high TIBC, and slightly elevated ferritin, a mixed picture could be considered, where both iron deficiency and an inflammatory component coexist.

• Do Not Miss Diagnoses

  • Thalassemia trait: Although the MCV is slightly below the normal range, thalassemia trait should be considered, especially if there's a family history or specific ethnic predisposition. However, the MCH and other parameters do not strongly suggest this diagnosis.
  • Sideroblastic anemia: This condition can present with variable iron studies, but typically, there would be evidence of increased iron storage (e.g., elevated ferritin), which is not prominently seen here.

• Rare Diagnoses

  • Other hemoglobinopathies: Conditions like hemoglobinopathies (other than thalassemia) could potentially present with abnormal hematologic indices, but they are less likely given the provided data.
  • Myelodysplastic syndromes: These syndromes can cause various forms of anemia, including those with abnormal iron studies, but they are rare and typically present with other cytopenias or specific bone marrow findings.