Differential Diagnosis for a 65 YOF with Syncopal Episodes
Single Most Likely Diagnosis
- Uterine bleeding due to fibroids: The patient's history of fibroids, severe anemia (HGB of 7.2), and recent syncopal episodes suggest that uterine bleeding is the most likely cause of her symptoms. The low hemoglobin level indicates significant blood loss, which is consistent with fibroid-related bleeding.
Other Likely Diagnoses
- Hypertensive emergency: The patient's history of hypertension and recent syncopal episodes raise the possibility of a hypertensive emergency, which could be causing her symptoms. However, the severe anemia is more suggestive of uterine bleeding.
- Infection: The elevated WBC (19.9) with a high neutrophil count (16.4) suggests a possible infection, which could be contributing to her symptoms. However, the primary cause of her anemia and syncopal episodes is more likely related to uterine bleeding.
- Diabetic complication: The patient's history of diabetes and recent symptoms could be related to a diabetic complication, such as hypoglycemia or hyperglycemia. However, the severe anemia and uterine bleeding are more likely causes of her symptoms.
Do Not Miss Diagnoses
- Cardiac arrhythmia or myocardial infarction: Although less likely, a cardiac arrhythmia or myocardial infarction could be causing the patient's syncopal episodes and would be deadly if missed. The patient's history of hypertension and diabetes increases her risk for cardiac disease.
- Sepsis: The elevated WBC count could indicate sepsis, which would be a life-threatening condition if not promptly diagnosed and treated.
- Bleeding disorder: A bleeding disorder, such as a coagulopathy, could be contributing to the patient's uterine bleeding and would be important to diagnose and treat.
Rare Diagnoses
- Gastrointestinal bleeding: Although less likely, gastrointestinal bleeding could be causing the patient's anemia and syncopal episodes. However, the patient's history of fibroids and uterine bleeding makes this diagnosis less likely.
- Hematologic malignancy: A hematologic malignancy, such as leukemia, could be causing the patient's anemia and elevated WBC count. However, this diagnosis is less likely and would require further evaluation and testing to confirm.