Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: July 7, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Anemia Differential Diagnosis

The patient's laboratory results show a hemoglobin level of 9.9 g/dL, hematocrit of 29.8%, mean corpuscular volume (MCV) of 99 fL, and mean corpuscular hemoglobin (MCH) of 33.7 pg. Based on these values, we can categorize the differential diagnosis as follows:

  • Single most likely diagnosis

    • Macrocytic Anemia: The patient's MCV is elevated at 99 fL, which is above the normal range, indicating that the red blood cells are larger than normal. This, combined with the low hemoglobin and hematocrit levels, suggests a macrocytic anemia. Common causes include vitamin B12 or folate deficiency.

  • Other Likely diagnoses

    • Normocytic Anemia with artifactually elevated MCV: Although the MCV is slightly elevated, it's close to the upper limit of normal. If there's an error in the measurement or an artifact affecting the MCV, the patient could actually have a normocytic anemia. Causes of normocytic anemia include chronic disease, anemia of chronic kidney disease, or bone marrow disorders.
    • Mixed Anemia: The patient's MCV is at the upper limit of normal, and there could be a mixed picture with both macrocytic and microcytic components. This would require further investigation, including reticulocyte count, iron studies, and possibly a bone marrow biopsy.

  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

    • Hemolytic Anemia: Although less likely given the MCV, a hemolytic anemia could present with an elevated MCV if there's a component of reticulocytosis (immature red blood cells) which are larger than mature red cells. Conditions like autoimmune hemolytic anemia or paroxysmal nocturnal hemoglobinuria (PNH) need to be considered.
    • Myelodysplastic Syndrome (MDS): MDS can present with macrocytic anemia and is a condition that would have significant implications for the patient's prognosis and management.

  • Rare diagnoses

    • Ornithine Transcarbamylase Deficiency: A rare genetic disorder that can lead to macrocytic anemia due to impaired folate metabolism.
    • Congenital Dyserythropoietic Anemia: A group of rare genetic disorders characterized by ineffective erythropoiesis and macrocytic anemia.

Related Questions

Which condition is associated with raised Lactate Dehydrogenase (LDH) levels: Mechanical Aortic Valve or Cholestasis?
What is the workup for costoclavicular syndrome?
Should a female with hyperprolactinemia be given testosterone replacement therapy?
How often should a patient with diabetes see their primary care physician (PCP) to monitor their condition?
How does Subacromial Bursitis present, can it cause sudden pain under the clavicle, and is ultrasound a useful diagnostic tool?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question