Differential Diagnosis for Anemia in a 21-year-old African American College Student
- Single most likely diagnosis
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency: This condition is more common in African American males and can be triggered by certain medications, such as trimethoprim-sulfamethoxazole, leading to hemolytic anemia. The recent episode of cystitis treated with this antibiotic, followed by the onset of anemia, supports this diagnosis. The elevated reticulocyte count indicates an appropriate bone marrow response to the anemia, suggesting a hemolytic process.
- Other Likely diagnoses
- Iron deficiency anemia: Although the patient has been following a supervised vegetarian diet, iron deficiency remains a possibility, especially if the diet is not well planned. However, the mean corpuscular volume (MCV) is within the normal range, which makes this diagnosis less likely.
- Vitamin deficiency (e.g., vitamin B12 or folate deficiency): These deficiencies can occur in individuals with poorly planned vegetarian diets. However, the supervised nature of the patient's diet and the absence of other symptoms (e.g., neurological symptoms in vitamin B12 deficiency) make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sickle cell disease: Although less likely given the patient's age and the absence of previous episodes, sickle cell disease can cause anemia and is particularly important to consider in African American patients. It could be a consideration if other diagnoses are ruled out.
- 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. The recent onset of anemia and hemolysis (suggested by the elevated reticulocyte count) could prompt consideration of PNH, especially if G6PD deficiency is ruled out.
- Rare diagnoses
- Autoimmune hemolytic anemia: This condition involves the immune system producing antibodies against the patient's own red blood cells, leading to their destruction. It is less common and would typically present with a more complex clinical picture.
- Other drug-induced hemolytic anemias: Besides G6PD deficiency, other medications can induce hemolytic anemia through different mechanisms, but these are rare and would depend on the patient's medication history.