Differential Diagnosis for a 32-year-old Female with UC and Anemia
- Single most likely diagnosis:
- Anemia of chronic disease: This is the most likely diagnosis given the patient's underlying condition of ulcerative colitis (UC), which is a chronic inflammatory disease. The elevated CRP (14.9) indicates active inflammation, and the iron studies show a low iron level (9) with a low iron saturation (0.14) but a relatively low ferritin (20), which can be seen in anemia of chronic disease due to the body's inability to utilize iron effectively during inflammation.
- Other Likely diagnoses:
- Iron deficiency anemia: Although the ferritin level is low, which typically indicates iron deficiency, the presence of chronic inflammation from UC complicates the interpretation. Ferritin is an acute-phase reactant and can be elevated in the presence of inflammation, but in this case, it's low, suggesting that iron deficiency could also be a contributing factor.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Vitamin B12 deficiency anemia: Given the patient's history of UC, there's a potential for malabsorption, including vitamin B12, especially if she has had parts of her ileum removed or has significant ileal disease. This would require a specific test (vitamin B12 level) to diagnose.
- Anemia due to gastrointestinal bleeding: UC can cause chronic blood loss leading to anemia. Although the patient's Hgb/Hct and MCV suggest a microcytic anemia, chronic blood loss could contribute to iron deficiency over time.
- Rare diagnoses:
- Sideroblastic anemia: This is a rare condition characterized by the presence of ringed sideroblasts in the bone marrow and can be associated with various conditions, including myelodysplastic syndromes. It's less likely but could be considered if other diagnoses are ruled out and the patient's anemia does not respond to treatment.
- Celiac disease: Although less common, celiac disease can cause malabsorption, including iron, leading to anemia. It's worth considering, especially if the patient has other symptoms suggestive of celiac disease, given the association between celiac disease and UC.