Differential Diagnosis

The patient presents with a high total iron level of 184 (normal range 37-145) and a ferritin level of 26.2, without being on iron supplements. Given the normal CBC, CMP, and no diabetes, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Hemochromatosis: This is a genetic disorder characterized by excessive iron accumulation in the body. The high total iron level and the presence of ferritin, although not extremely elevated, in the context of no iron supplementation, make this a plausible diagnosis. However, genetic testing and further evaluation would be necessary for confirmation.

• Other Likely Diagnoses

  • Hemosiderosis: This condition involves the accumulation of hemosiderin in tissues, which can occur due to various factors including excessive iron intake or repeated blood transfusions. Although the patient is not on iron supplements, other sources of iron or conditions leading to increased iron absorption could be considered.
  • Inflammatory Conditions: Certain chronic inflammatory conditions can lead to increased ferritin levels as an acute-phase reactant. The relatively low ferritin level in this case might not strongly support this, but it remains a consideration, especially if other signs of inflammation are present.

• Do Not Miss Diagnoses

  • Thalassemia Major: Although less likely given the normal CBC, thalassemia major can lead to increased iron levels due to frequent blood transfusions. It's crucial to rule out this condition due to its significant implications on management and prognosis.
  • Hepatocellular Carcinoma: Elevated ferritin levels can be associated with hepatocellular carcinoma, especially in the context of chronic liver disease. Although the patient's CMP is normal, liver imaging and further evaluation might be warranted to rule out underlying liver pathology.

• Rare Diagnoses

  • Aceruloplasminemia: A rare genetic disorder characterized by iron accumulation in the brain and other organs due to a lack of ceruloplasmin, a protein necessary for iron transport. This condition would typically present with neurological symptoms and is very rare.
  • Neonatal Hemochromatosis: Although the patient's age is not specified, if the patient is an infant, neonatal hemochromatosis could be considered. This is a rare condition of severe iron overload presenting in the neonatal period.