Differential Diagnosis for Decreasing Ferritin and Hemoglobin

Single Most Likely Diagnosis

• Iron Deficiency Anemia: This is the most common cause of decreasing ferritin and hemoglobin levels. Iron deficiency anemia occurs when the body does not have enough iron to produce adequate amounts of hemoglobin, a substance in red blood cells that carries oxygen to different parts of the body. The decrease in ferritin, which is a protein that stores iron, directly indicates a reduction in the body's iron stores.

Other Likely Diagnoses

• Chronic Blood Loss: Conditions such as ulcers, cancer, or inflammatory bowel disease can lead to chronic blood loss, depleting the body's iron stores and resulting in decreased ferritin and hemoglobin levels.
• Inadequate Iron Intake: A diet lacking sufficient iron, especially in individuals with increased iron requirements such as pregnant women, can lead to iron deficiency anemia.
• Chronic Diseases: Certain chronic diseases like rheumatoid arthritis, chronic infections, or malignancies can cause anemia of chronic disease, which may present with decreased ferritin and hemoglobin levels due to the body's inflammatory response.

Do Not Miss Diagnoses

• Gastrointestinal Cancer: Although less common, gastrointestinal cancers can cause chronic blood loss leading to iron deficiency anemia. Early detection is crucial for treatment and survival.
• Celiac Disease: An autoimmune disorder that can lead to malabsorption of nutrients, including iron, resulting in decreased ferritin and hemoglobin levels.
• Pernicious Anemia: An autoimmune condition causing a deficiency in vitamin B12, which is essential for the production of red blood cells. While it primarily affects vitamin B12 levels, it can also lead to a decrease in hemoglobin.

Rare Diagnoses

• Hemoglobinopathies: Genetic disorders affecting the production or structure of hemoglobin, such as thalassemia or sickle cell disease, which can lead to anemia and alterations in ferritin levels due to increased red blood cell turnover.
• Atransferrinemia: A rare genetic disorder characterized by a lack of transferrin, a protein necessary for the transport of iron in the blood, leading to severe iron deficiency anemia.
• Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, which can result in decreased hemoglobin levels and potentially affect ferritin due to chronic hemolysis.