Differential Diagnosis
- Single most likely diagnosis
- Hemorrhage or bleeding complication: Given the patient's history of recent fall, multiple contusions, and sudden onset of shortness of breath (SOB), along with low hemoglobin (Hgb 7.37) and thrombocytopenia (PLT 64), a hemorrhage or bleeding complication is highly plausible. The patient's denial of gastrointestinal bleeding symptoms does not rule out internal bleeding, especially considering the recent trauma.
- Other Likely diagnoses
- Sepsis: Although the patient does not have overt signs of infection like fever or localized tenderness, the combination of low WBC (2.56), anemia, and acute kidney injury (indicated by elevated Cr 333) could suggest a systemic infection, particularly in an elderly patient with multiple comorbidities.
- Anemia of chronic disease: The patient has chronic kidney disease (CKD) and polycythemia vera, which can lead to anemia of chronic disease. The elevated ferritin level (1471) might indicate an inflammatory process or iron overload, but in the context of CKD and recent blood transfusions, it's also consistent with anemia of chronic disease.
- Cardiac complications: Given the patient's history of hypertension (HTN) and recent symptoms of SOB, cardiac complications such as heart failure or myocardial infarction should be considered, especially in the context of anemia and possible bleeding.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary embolism (PE): Although the patient has multiple risk factors for bleeding, the sudden onset of SOB and history of recent immobility (fall and possible subsequent decreased mobility) increase the risk for PE, which is a medical emergency.
- Aortic dissection or rupture: The patient's history of HTN and recent trauma (fall) makes aortic dissection or rupture a possibility, especially if the patient had a sudden, severe onset of back or chest pain, which is not explicitly mentioned but should be considered.
- Intra-abdominal hemorrhage: Despite the absence of abdominal tenderness, an intra-abdominal hemorrhage could be masked by the patient's anticoagulated state (if on anticoagulants for polycythemia vera) or decreased sensation due to age or other factors.
- Rare diagnoses
- Thrombotic thrombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS): These conditions are characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, and neurological symptoms. Although rare, they should be considered in the differential diagnosis due to the patient's thrombocytopenia, anemia, and renal impairment.
- Paroxysmal nocturnal hemoglobinuria (PNH): This rare, acquired, life-threatening disease of the blood is characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombotic events. The patient's anemia, thrombocytopenia, and history of blood transfusions might suggest this diagnosis, although it is less likely.