Differential Diagnosis for a 55-year-old Female with Low H&H and High Platelets
Single Most Likely Diagnosis
- Iron Deficiency Anemia: This is often the most common cause of low hemoglobin (H) and hematocrit (Hct) in adults, particularly in women of this age group due to menstrual losses or gastrointestinal bleeding. The body's response to anemia can sometimes include a reactive thrombocytosis (high platelet count).
Other Likely Diagnoses
- Chronic Disease Anemia: Conditions like chronic kidney disease, rheumatoid arthritis, or other chronic inflammatory diseases can lead to anemia of chronic disease, which might present with low H&H. However, the high platelet count is less commonly associated with these conditions.
- Thalassemia: Certain types of thalassemia can present with microcytic anemia (low H&H) and sometimes with elevated platelet counts, especially if there's a component of iron deficiency or a reactive response.
- Vitamin Deficiency Anemia: Deficiencies in vitamins like B12 or folate can cause anemia, but the high platelet count is less typical unless there's a co-existing condition.
Do Not Miss Diagnoses
- Gastrointestinal Bleeding: A source of bleeding in the GI tract could explain both the anemia and the thrombocytosis as a reactive response. Missing this diagnosis could be life-threatening.
- Malignancy: Certain cancers can cause anemia and thrombocytosis, either through direct effects or through paraneoplastic syndromes. Examples include gastrointestinal, genitourinary, or lung cancers.
- Myeloproliferative Neoplasms (MPN): Conditions like essential thrombocythemia or polycythemia vera can present with elevated platelet counts and sometimes anemia, depending on the specific disorder and its stage.
Rare Diagnoses
- Splenectomy or Hyposplenism: The absence or dysfunction of the spleen can lead to an increase in circulating platelets due to the spleen's role in platelet sequestration. Anemia could co-exist due to various reasons, including underlying disease processes.
- 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. It can present with anemia and sometimes thrombocytosis.