Differential Diagnosis
- Single most likely diagnosis
- Iron deficiency: The patient's laboratory results show a low hemoglobin level (9 g/dL) and hematocrit (29%), which are indicative of anemia. The mean corpuscular volume (MCV) is 110 fL, which is slightly elevated, but the red cell distribution width (RDW) is 13.1%, suggesting a variation in red blood cell size that can be seen in iron deficiency anemia, especially in the context of chronic blood loss. Given the patient's history of cirrhosis and lack of screening for varices, it is likely that he has gastrointestinal bleeding, which would lead to iron deficiency anemia.
- Other Likely diagnoses
- Vitamin B12 deficiency: Although the patient's vitamin B12 level is within the normal range (450 pg/mL), folate level is slightly low (18 ng/mL), and the MCV is elevated, suggesting a possible component of megaloblastic anemia. However, the primary issue seems to be iron deficiency.
- Blood loss anemia: This is closely related to iron deficiency anemia in this context, as the blood loss (likely from varices due to cirrhosis) would lead to iron deficiency over time.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Direct bone marrow toxicity: While less likely given the information, direct bone marrow toxicity from alcohol or other substances could lead to anemia and other cytopenias. It's crucial to consider this, especially given the patient's history of alcohol use disorder.
- Rare diagnoses
- Hemoglobinopathy: There's no specific indication in the patient's history or lab results that would suggest a hemoglobinopathy (e.g., thalassemia, sickle cell disease) as the primary cause of his anemia. These conditions typically present earlier in life and have distinct diagnostic features.
- Vitamin B12 deficiency as a sole cause is less likely given the normal vitamin B12 level, but it's worth monitoring, especially if folate levels are borderline, as seen in this patient.