Differential Diagnosis

The patient's laboratory results show a normal hemoglobin level, low total iron, low transferrin saturation, and elevated ferritin. Based on these findings, the following differential diagnoses can be considered:

• Single Most Likely Diagnosis

  • Anemia of Chronic Disease (ACD): The patient's low total iron and low transferrin saturation, combined with elevated ferritin, are consistent with ACD. This condition is characterized by a decrease in iron availability due to chronic inflammation, despite adequate iron stores.

• Other Likely Diagnoses

  • Iron Deficiency Anemia with Inflammation: Although the ferritin level is elevated, which typically indicates adequate iron stores, it can also be increased in response to inflammation. Therefore, it is possible that the patient has iron deficiency anemia with a concurrent inflammatory process.
  • Chronic Kidney Disease (CKD): CKD can lead to anemia and alterations in iron metabolism, including elevated ferritin levels. The patient's laboratory results could be consistent with CKD, especially if there are other signs or symptoms suggestive of renal disease.

• Do Not Miss Diagnoses

  • Hemochromatosis: Although the patient's transferrin saturation is low, which is not typical for hemochromatosis, it is essential to consider this diagnosis due to its potential severity. Hemochromatosis can lead to significant organ damage if left untreated.
  • Malignancy: Certain types of cancer, such as lymphoma or hepatocellular carcinoma, can cause alterations in iron metabolism and lead to elevated ferritin levels. It is crucial to rule out malignancy, especially if there are other suspicious symptoms or findings.

• Rare Diagnoses

  • Porphyria Cutanea Tarda: This rare genetic disorder can cause elevated ferritin levels and alterations in iron metabolism. However, it is typically associated with other symptoms, such as skin blistering and fragility.
  • Aceruloplasminemia: This rare genetic disorder is characterized by a lack of ceruloplasmin, leading to iron accumulation in tissues and elevated ferritin levels. However, it is typically associated with neurological symptoms and other signs of iron overload.