Differential Diagnosis for a 31-year-old Female with EGA 30+5, Hemoglobin 11, and Ferritin 47

• Single most likely diagnosis:
  • Dilutional anemia: This condition occurs due to an increase in plasma volume, which is common in pregnancy, leading to a dilutional effect on the concentration of red blood cells. The patient's hemoglobin level of 11 g/dL and ferritin of 47 ng/mL, in the context of being at 30+5 weeks of gestation, support this diagnosis. The previous negative hemoglobinopathy screening further points towards a physiological rather than a pathological cause.
• Other Likely diagnoses:
  • Iron deficiency anemia: Although the ferritin level is 47 ng/mL, which is generally considered adequate, iron deficiency can still occur, especially in pregnancy due to increased demand. However, the ferritin level suggests that iron stores are not severely depleted.
  • Anemia of chronic disease: This could be considered if there were underlying chronic conditions, but none are mentioned in the scenario provided.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Hemoglobinopathy (e.g., thalassemia or sickle cell disease): Despite a previous negative screening, it's crucial to ensure that the initial test was accurate and that the patient hasn't developed any new conditions. However, given the previous negative result, this is less likely.
  • Acute blood loss: Though not directly indicated by the information provided, any form of bleeding (e.g., placental abruption, placenta previa) could lead to anemia. The hemoglobin level could be a sign of blood loss, especially if it has dropped significantly from previous measurements.
• Rare diagnoses:
  • Other nutritional deficiencies (e.g., folate or vitamin B12 deficiency): These could lead to anemia but are less common in the general population and would typically present with other symptoms or laboratory findings.
  • Bone marrow disorders or other hematological conditions: These are rare and would likely have other associated symptoms or abnormal laboratory findings beyond a mild anemia.