Differential Diagnosis for High Fibrinogen, High RDW, and High LDH
Single Most Likely Diagnosis
- Chronic Myeloid Leukemia or Myeloproliferative Neoplasm: These conditions can lead to increased fibrinogen due to chronic inflammation and increased cell turnover, elevated RDW (Red Cell Distribution Width) due to variation in red blood cell size, and high LDH (Lactate Dehydrogenase) from cell lysis.
Other Likely Diagnoses
- Polycythemia Vera: A myeloproliferative disorder that can cause an increase in fibrinogen due to chronic inflammation, elevated RDW due to the production of red blood cells of varying sizes, and high LDH from increased cell turnover.
- Chronic Lymphocytic Leukemia (CLL): CLL can lead to elevated LDH due to cell lysis, increased RDW due to anisocytosis (variation in red blood cell size), and high fibrinogen as an acute phase reactant in response to chronic disease.
- Myelodysplastic Syndromes (MDS): MDS can cause ineffective erythropoiesis leading to high RDW, elevated LDH from intramedullary hemolysis, and increased fibrinogen as part of the chronic disease process.
Do Not Miss Diagnoses
- Hemolytic Anemia (especially Sickle Cell Disease or Autoimmune Hemolytic Anemia): These conditions can cause high LDH due to hemolysis, elevated RDW due to the presence of both reticulocytes and older red cells, and increased fibrinogen as an acute phase reactant.
- Lymphoma: Certain types of lymphoma can lead to high LDH due to tumor lysis, increased RDW due to anemia of chronic disease, and elevated fibrinogen as part of the inflammatory response to the tumor.
Rare Diagnoses
- Primary Myelofibrosis: A myeloproliferative neoplasm that can cause elevated fibrinogen, high RDW due to the production of abnormal red cells, and increased LDH from cell turnover and fibrosis in the bone marrow.
- Gaucher's Disease: A rare genetic disorder that can lead to elevated LDH due to cell lysis, high RDW due to anemia, and increased fibrinogen as part of the chronic disease process.
- Histiocytosis: Rare conditions like Langerhans cell histiocytosis can cause high LDH, elevated RDW, and increased fibrinogen due to the infiltration of histiocytes into various organs, including the bone marrow.