Differential Diagnosis

The patient's laboratory results show a hemoglobin (HGB) level of 124 g/L, hematocrit (HCT) of 0.39, red blood cell (RBC) count of 4.08 million cells/μL, iron level of 8 μmol/L, ferritin level of 146 μg/L, and total iron-binding capacity (TIBC) of 48 μmol/L. Based on these results, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Anemia of Chronic Disease (ACD): The patient has a low iron level but a high ferritin level, which is indicative of anemia of chronic disease. The high ferritin level suggests that the body is holding onto iron, which is not being utilized effectively to produce red blood cells. This condition is often seen in patients with chronic infections, inflammation, or malignancies.

• Other Likely Diagnoses

  • Iron Deficiency Anemia (IDA): Although the ferritin level is high, which might argue against IDA, the low iron level and high TIBC could still suggest some degree of iron deficiency, especially if there's a mixed picture due to co-existing conditions.
  • Chronic Kidney Disease (CKD): CKD can lead to a normocytic anemia due to decreased erythropoietin production. The high ferritin level could be seen in CKD due to inflammation or as a marker of disease severity.

• Do Not Miss Diagnoses

  • Hemochromatosis: Although less likely given the low iron level, it's crucial not to miss this diagnosis. However, the presentation would typically include high iron levels and saturation, which is not the case here.
  • Thalassemia: Certain types of thalassemia can present with normocytic anemia and elevated ferritin levels due to increased iron absorption. It's essential to consider this, especially if there's a family history or specific ethnic predisposition.

• Rare Diagnoses

  • Sideroblastic Anemia: This is a group of disorders characterized by the presence of ringed sideroblasts in the bone marrow. It can present with normocytic anemia, high ferritin levels, and variable iron levels. It's less common but should be considered in the differential diagnosis of anemia with high ferritin levels.
  • Porphyrias: Some porphyrias can affect heme synthesis and lead to anemia with abnormal iron studies. They are rare and typically present with other systemic symptoms, but they should not be overlooked in complex cases.