Anemia Differential Diagnosis

Based on the provided laboratory values, the following differential diagnosis is considered:

• Single most likely diagnosis

  • Iron deficiency anemia: The patient's low MCH (25.8 pg) and MCHC (30.5 g/dL) values, along with a high RDW (17.0%), are consistent with iron deficiency anemia. The high RDW indicates a significant variation in red blood cell size, which is often seen in iron deficiency anemia.

• Other Likely diagnoses

  • Anisopoikilocytosis (mixed anemia): The combination of low MCH and MCHC with a high RDW may also suggest a mixed anemia, where there is a combination of iron deficiency and another type of anemia, such as vitamin deficiency or anemia of chronic disease.
  • Thalassemia trait: Although less likely, thalassemia trait can also present with low MCH and MCHC values, along with a high RDW. However, other laboratory tests, such as hemoglobin electrophoresis, would be needed to confirm this diagnosis.

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

  • Sideroblastic anemia: This rare condition can present with similar laboratory findings, including low MCH and MCHC, and a high RDW. However, it is often associated with other systemic symptoms and requires specific testing for diagnosis.
  • Myelodysplastic syndrome (MDS): MDS can also present with anemia and abnormal laboratory values, including a high RDW. Although less likely, MDS is a potentially life-threatening condition that requires prompt diagnosis and treatment.

• Rare diagnoses

  • Congenital dyserythropoietic anemia: This rare group of disorders can present with anemia, low MCH and MCHC, and a high RDW. However, they are often associated with other congenital abnormalities and require specific testing for diagnosis.
  • Other rare anemias, such as pyruvate kinase deficiency or glucose-6-phosphate dehydrogenase deficiency, can also present with similar laboratory findings. However, these conditions are relatively rare and would require specific testing for diagnosis.