Differential Diagnosis for a 22-year-old Male with Abnormal Screening Labs
The patient presents with abnormal iron levels, which is the primary concern. The differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Iron Deficiency Anemia: This is the most likely diagnosis given the patient's low iron level (49 mcg/dL), low iron saturation (13%), and high TIBC (389 mcg/dL). The patient's hemoglobin and hematocrit levels are within the normal range, but the low iron level and high TIBC are indicative of iron deficiency anemia.
Other Likely Diagnoses
- Anemia of Chronic Disease: Although the patient's iron level is low, the TIBC is also elevated, which could suggest anemia of chronic disease. However, without other symptoms or laboratory results indicating a chronic disease, this diagnosis is less likely.
- Thalassemia Trait: The patient's MCV (90.1 FL) is within the normal range, but the MCH (29.4 pcg) is slightly low. Thalassemia trait could be a possibility, but it would not explain the low iron level.
Do Not Miss Diagnoses
- Celiac Disease: This is an autoimmune disorder that can cause iron deficiency anemia due to malabsorption. Although it may not be the most likely diagnosis, it is essential to consider it, as celiac disease can have severe consequences if left untreated.
- Gastrointestinal Bleeding: A source of chronic blood loss, such as gastrointestinal bleeding, could cause iron deficiency anemia. This diagnosis is crucial to consider, as it could be life-threatening if not addressed promptly.
Rare Diagnoses
- Hemochromatosis: Although the patient's iron level is low, it is essential to consider hemochromatosis, a genetic disorder that can cause iron overload. However, this diagnosis is unlikely given the patient's low iron level.
- Sideroblastic Anemia: This is a rare disorder characterized by the accumulation of iron in the mitochondria of red blood cell precursors. It could cause iron deficiency anemia, but it is a rare condition and would require further testing to diagnose.