Differential Diagnosis

The patient's laboratory results show a mix of normal and slightly abnormal values. Here's a differential diagnosis based on the provided information:

• Single most likely diagnosis:

  • Viral gastroenteritis or a mild viral infection: The slightly elevated liver enzymes (AST and ALT) and the presence of a normal to slightly low white blood cell count with a relatively normal differential count could suggest a viral infection. The patient's other parameters are largely within normal limits, which aligns with a self-limiting condition like viral gastroenteritis.

• Other Likely diagnoses:

  • Mild anemia: The patient's hemoglobin and hematocrit are at the lower end of the normal range, and the MCV (Mean Corpuscular Volume) is slightly below the normal range, suggesting a microcytic anemia. However, the RDW (Red Cell Distribution Width) is within normal limits, which might indicate that the anemia is not significantly impacting the red blood cell size variability.
  • Dehydration or mild renal impairment: The slightly elevated BUN (Blood Urea Nitrogen) and creatinine, along with a normal eGFR (estimated Glomerular Filtration Rate), could suggest mild dehydration or early renal impairment, though the eGFR is still within a relatively normal range.
  • Mild liver dysfunction: The elevated AST and ALT suggest some level of liver stress or injury, but without more significant elevations or other liver function test abnormalities, this could be due to a variety of non-specific causes.

• Do Not Miss diagnoses:

  • Hemolytic anemia: Although less likely given the lack of significant jaundice (total bilirubin is only slightly elevated), hemolytic anemias can present with variable degrees of anemia and sometimes normal or near-normal liver function tests. The slightly low MCV and MCHC (Mean Corpuscular Hemoglobin Concentration) could be hints, but more specific tests for hemolysis (like LDH, indirect bilirubin, and haptoglobin) would be needed.
  • Chronic kidney disease: While the eGFR is 88, which is within the normal range, the slightly elevated creatinine and BUN could be early signs of renal impairment, especially if the patient has risk factors for kidney disease.
  • Celiac disease: The presence of a very low tTG (tissue transglutaminase) antibody level and a slightly elevated gliadin DGP (deamidated gliadin peptide) antibody could suggest celiac disease, although the IgA level is normal, and the patient's gastrointestinal symptoms are not explicitly mentioned.

• Rare diagnoses:

  • Thalassemia trait: Given the microcytic anemia (low MCV) without significant anisocytosis (normal RDW), a thalassemia trait could be considered, especially if the patient has a relevant ethnic background. However, specific tests for thalassemia (like hemoglobin electrophoresis) would be needed for diagnosis.
  • Wilson's disease: This rare genetic disorder can cause liver dysfunction and sometimes hematologic abnormalities. However, it would typically present with more significant liver enzyme elevations and possibly low serum ceruloplasmin levels, which are not provided here.