Differential Diagnosis for Abnormal CBC Results

The provided CBC results show a patient with anemia (low hemoglobin and hematocrit), microcytic hypochromic anemia indicators (low MCV, MCH, and MCHC), and elevated platelets. Based on these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Iron deficiency anemia: This is the most likely diagnosis given the microcytic hypochromic anemia (low MCV, MCH, and MCHC) and the elevated RDW, which suggests a variation in red blood cell size. The body's response to chronic blood loss or inadequate iron intake often leads to this condition.
• Other Likely Diagnoses
  • Thalassemia: This genetic disorder affects hemoglobin production and can cause microcytic anemia. However, it typically presents with a more significant reduction in MCV and often with target cells on the peripheral smear.
  • Anemia of chronic disease: This condition can also present with microcytic anemia, especially if there's an underlying chronic inflammatory or infectious process. The elevated platelet count could be a reactive response to the chronic disease.
  • Sideroblastic anemia: A disorder where the bone marrow fails to utilize iron to create hemoglobin, leading to microcytic hypochromic anemia. It can be congenital or acquired due to various factors, including drugs, toxins, or myelodysplastic syndromes.
• Do Not Miss Diagnoses
  • Bleeding disorder or gastrointestinal bleeding: Although the primary indicators point towards iron deficiency anemia, it's crucial not to miss a potential source of bleeding, which could be life-threatening if not addressed promptly. The elevated platelet count could be a response to blood loss.
  • Malignancy: Certain cancers can lead to anemia of chronic disease or even iron deficiency anemia if there's associated bleeding. The elevated platelet count (thrombocytosis) can also be a paraneoplastic syndrome.
• Rare Diagnoses
  • Hemoglobinopathies other than thalassemia: Such as hemoglobin E disease or other rare hemoglobinopathies that can cause microcytic anemia.
  • Myelodysplastic syndromes (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells, which can lead to various types of anemia, including sideroblastic anemia.
  • Lead poisoning: Can cause microcytic anemia due to its effect on heme synthesis. However, this would typically be associated with other symptoms and findings.

Each of these diagnoses requires further investigation, including a detailed patient history, physical examination, and additional laboratory tests to confirm the underlying cause of the anemia and thrombocytosis.