Differential Diagnosis for Sue
Single Most Likely Diagnosis
- Anemia of Chronic Disease: Given Sue's low hemoglobin (9.5) and hematocrit (29.4) levels, along with a slightly elevated MCV (100.4) and MCH (33.6), anemia of chronic disease is a strong consideration. The consistent WBC count of 2.81 could be indicative of a chronic condition affecting her bone marrow or an underlying inflammatory process.
Other Likely Diagnoses
- Vitamin B12 or Folate Deficiency: The elevated MCV suggests a macrocytic anemia, which could be due to a deficiency in vitamin B12 or folate. This would explain the low hemoglobin and hematocrit levels.
- Chronic Kidney Disease (CKD): CKD can lead to anemia due to decreased erythropoietin production. Sue's age and the presence of anemia make this a plausible diagnosis.
- Chronic Infection or Inflammation: A chronic infection or inflammatory process could explain the consistent WBC count and anemia. Conditions such as tuberculosis, osteomyelitis, or rheumatoid arthritis should be considered.
Do Not Miss Diagnoses
- Leukemia or Lymphoma: Although less likely, a diagnosis of leukemia or lymphoma could explain the abnormal WBC count and anemia. These conditions require prompt diagnosis and treatment.
- Bone Marrow Failure Syndrome: Aplastic anemia or myelodysplastic syndrome could lead to pancytopenia (low counts of all blood cell types) and should not be missed due to their severe implications.
- Sepsis: Although Sue's WBC count is low, sepsis can present with an abnormal WBC count, and given her age and anemia, it is crucial not to miss this potentially life-threatening condition.
Rare Diagnoses
- Pure Red Cell Aplasia: A rare condition characterized by the failure of the bone marrow to produce red blood cells, leading to severe anemia.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombotic events.
- Myeloproliferative Neoplasms: A group of diseases that affect blood cell production in the bone marrow, leading to an overproduction of blood cells. Although less likely given Sue's low WBC count, some types can present with cytopenias.