Differential Diagnosis

The patient's laboratory results indicate a potential issue with their red blood cells. Here's a breakdown of the differential diagnosis:

• Single most likely diagnosis

  • Iron deficiency anemia: The patient's iron saturation is low at 14, and ferritin is also low at 21, indicating depleted iron stores. The MCH (mean corpuscular hemoglobin) and MCHC (mean corpuscular hemoglobin concentration) are slightly low, which can be seen in iron deficiency anemia. The RDW (red cell distribution width) is elevated at 16.2, which is consistent with iron deficiency anemia.

• Other Likely diagnoses

  • Thiamine deficiency: Although the thiamine level is within the normal range, it's on the lower end. Thiamine deficiency can cause anemia, and the patient's MCH and MCHC are slightly low.
  • Folate deficiency: The folate level is low at 17, which can cause anemia. However, the patient's homocysteine level is not provided, which would be helpful in confirming the diagnosis.
  • Anisocytosis (a condition characterized by unequal size of red blood cells): The elevated RDW suggests anisocytosis, which can be seen in various types of anemia, including iron deficiency anemia.

• Do Not Miss

  • Sideroblastic anemia: This is a rare condition characterized by the presence of ringed sideroblasts in the bone marrow. It can be caused by various factors, including genetic mutations, isoniazid therapy, and lead poisoning. Although the patient's iron saturation is low, sideroblastic anemia can cause an increase in ferritin levels, which is not seen in this case. However, it's essential to consider this diagnosis due to its potential severity.
  • Myelodysplastic syndrome (MDS): This is a group of disorders caused by poorly formed or dysfunctional blood cells. MDS can cause anemia, and the patient's laboratory results, such as the elevated RDW, could be consistent with this diagnosis. However, a bone marrow biopsy would be necessary to confirm the diagnosis.

• Rare diagnoses

  • Pernicious anemia: This is an autoimmune disorder that causes a deficiency in vitamin B12. Although the patient's B12 level is normal, pernicious anemia can cause anemia, and it's essential to consider this diagnosis due to its potential severity.
  • Pyridoxine deficiency: This is a rare condition caused by a deficiency in vitamin B6. Although the patient's B6 level is within the normal range, pyridoxine deficiency can cause anemia, and it's essential to consider this diagnosis due to its potential severity.