Differential Diagnosis for a 70-year-old man with dropping hemoglobin, neutrophils, and platelets
- Single most likely diagnosis:
- Myelodysplastic Syndrome (MDS): This condition is characterized by the ineffective production of blood cells, leading to cytopenias (low blood cell counts) such as anemia (low hemoglobin), neutropenia (low neutrophils), and thrombocytopenia (low platelets). It is a common diagnosis in elderly patients presenting with these symptoms.
- Other Likely diagnoses:
- Vitamin B12 or Folate Deficiency: Deficiencies in these vitamins can lead to ineffective erythropoiesis and thrombopoiesis, resulting in anemia, neutropenia, and thrombocytopenia.
- Chronic Lymphocytic Leukemia (CLL): CLL can cause bone marrow failure, leading to cytopenias due to the accumulation of malignant lymphocytes in the bone marrow.
- Myeloproliferative Neoplasms (MPN): Although more commonly associated with elevated blood cell counts, some MPNs, especially in their fibrotic phase or when transformed, can present with cytopenias.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
- Acute Leukemia: Both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) can present with bone marrow failure, leading to severe cytopenias. Prompt diagnosis and treatment are crucial for survival.
- Aplastic Anemia: A rare but potentially life-threatening condition where the bone marrow fails to produce blood cells, leading to severe cytopenias.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombosis.
- Rare diagnoses:
- Large Granular Lymphocytic (LGL) Leukemia: A rare form of leukemia that can cause cytopenias due to immune-mediated destruction of blood cells.
- Hairy Cell Leukemia: A rare, slow-growing cancer of the blood in which the bone marrow makes too many B cells (lymphocytes), leading to cytopenias.
- Inherited Bone Marrow Failure Syndromes (e.g., Fanconi Anemia): Although typically diagnosed in childhood, some cases may not be recognized until later in life, especially if mild.