Differential Diagnosis for Anemia

Based on the provided laboratory values (RBC 3.79, Hgb 12.0, Hematocrit 35.2, RDW 15.9, MCV 92.9), the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Normocytic Anemia: The mean corpuscular volume (MCV) is 92.9, which falls within the normal range (80-100 fL), indicating that the red blood cells are of normal size. The hemoglobin (Hgb) level is slightly below the normal range, suggesting anemia. Normocytic anemia can be caused by various factors, including acute blood loss, hemolysis, or bone marrow disorders.

• Other Likely Diagnoses

  • Mild Macrocytic Anemia: Although the MCV is within the normal range, it is on the higher end, and some sources may consider values above 90 fL as mildly elevated. Macrocytic anemia can be caused by vitamin B12 or folate deficiency, among other factors.
  • Anisocytic Anemia: The red cell distribution width (RDW) is elevated at 15.9, indicating a significant variation in red blood cell size. This can be seen in various types of anemia, including iron deficiency anemia, vitamin B12 or folate deficiency, and anisocytosis.

• Do Not Miss Diagnoses

  • Hemolytic Anemia: Although less likely, hemolytic anemia can present with normocytic or mildly macrocytic indices. It is crucial to consider this diagnosis, as it can be life-threatening if not promptly addressed. Causes include autoimmune hemolytic anemia, hereditary spherocytosis, or glucose-6-phosphate dehydrogenase (G6PD) deficiency.
  • Bone Marrow Failure: Bone marrow failure syndromes, such as aplastic anemia or myelodysplastic syndromes, can present with normocytic anemia. These conditions require prompt diagnosis and treatment to prevent severe complications.

• Rare Diagnoses

  • Sideroblastic Anemia: A rare disorder characterized by the presence of ringed sideroblasts in the bone marrow. It can present with normocytic or microcytic anemia.
  • Myeloproliferative Neoplasms: Rarely, myeloproliferative neoplasms, such as polycythemia vera or primary myelofibrosis, can present with anemia, although this is less common.