Differential Diagnosis for a 14-Week Pregnant Woman

Single Most Likely Diagnosis

• Iron Deficiency Anemia: The patient's low hematocrit (31%) and hemoglobin (10.3) levels, along with a history of nausea, vomiting, and poor dietary habits (lack of fruits and veggies, preference for meat), suggest iron deficiency anemia, which is common in pregnancy due to increased iron demands.

Other Likely Diagnoses

• Pregnancy-Related Morning Sickness: The symptoms of nausea, vomiting, and lack of appetite are consistent with pregnancy-related morning sickness, which can be severe enough to affect dietary intake and lead to nutritional deficiencies.
• Vitamin B12 Deficiency: The patient's preference for meat and avoidance of fruits and veggies could lead to a vitamin B12 deficiency, especially if she is not consuming fortified foods or supplements. The MCV (Mean Corpuscular Volume) of 106 suggests a macrocytic anemia, which can be seen in vitamin B12 deficiency.
• Folate Deficiency: Similar to vitamin B12, a folate deficiency could also present with macrocytic anemia and is a concern in pregnancy due to the increased demand for folate.

Do Not Miss Diagnoses

• Pernicious Anemia: Although less common, pernicious anemia (an autoimmune cause of vitamin B12 deficiency) could present with similar symptoms and would be critical to diagnose due to its potential for neurological complications if left untreated.
• Hemolytic Anemia: Any form of hemolytic anemia (e.g., autoimmune hemolytic anemia) could present with anemia and would be crucial to diagnose due to the potential for severe outcomes if not managed properly.
• Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can present with nausea, vomiting, and changes in appetite. Thyroid dysfunction during pregnancy can have significant effects on both the mother and the fetus, making it a critical diagnosis not to miss.

Rare Diagnoses

• Celiac Disease: Although rare, celiac disease could lead to malabsorption of essential nutrients, including iron, folate, and vitamin B12, resulting in anemia. The patient's dietary preferences and gastrointestinal symptoms could be consistent with celiac disease, especially if she has not been diagnosed or managed for this condition.
• Gaucher's Disease: A rare genetic disorder that can cause anemia due to spleen enlargement and subsequent hemolysis. It would be an unusual cause of anemia in pregnancy but could be considered in the differential diagnosis if other causes are ruled out.