Differential Diagnosis

The patient's laboratory results show a low hemoglobin (Hb) level of 75, indicating anemia, with a mean corpuscular volume (MCV) of 87.5, which is within the normal range, suggesting a normocytic anemia. The Total Iron Binding Capacity (TIBC) is low at 32.5 umol/L, iron saturation is 17.2%, and ferritin is elevated at 314. These findings can help narrow down the differential diagnosis.

• Single Most Likely Diagnosis

  • Anemia of Chronic Disease (ACD): This condition is characterized by low iron levels, low TIBC, and elevated ferritin, which matches the patient's lab results. ACD is often seen in patients with chronic infections, inflammatory conditions, or malignancies. The elevated ferritin level, in particular, is a hallmark of ACD, as it reflects the body's inflammatory response and sequestration of iron.

• Other Likely Diagnoses

  • Iron Deficiency Anemia (IDA) with Inflammation: Although the ferritin level is elevated, which is not typical for IDA, the presence of inflammation can cause an increase in ferritin. However, the low TIBC and iron saturation are more suggestive of ACD.
  • Chronic Kidney Disease (CKD) related Anemia: CKD can lead to a complex anemia picture, including elements of ACD, IDA, and erythropoietin deficiency. The normocytic anemia and elevated ferritin could be consistent with CKD, but specific kidney function tests would be needed to support this diagnosis.

• Do Not Miss Diagnoses

  • Hemophagocytic Lymphohistiocytosis (HLH): This rare but life-threatening condition can present with anemia, elevated ferritin, and low iron levels due to the consumption of iron by activated macrophages. Although less likely, HLH is a critical diagnosis not to miss due to its high mortality rate if untreated.
  • Malignancy: Certain malignancies can cause anemia through various mechanisms, including ACD, bone marrow infiltration, or bleeding. The elevated ferritin could be a marker of inflammation or tumor activity.

• Rare Diagnoses

  • Porphyria Cutanea Tarda: This rare genetic disorder can lead to elevated ferritin levels and iron overload, but it typically presents with skin manifestations and does not directly cause anemia.
  • Hyperferritinemia Cataract Syndrome: A rare genetic condition characterized by elevated ferritin levels without iron overload, which is unlikely to be the primary cause of the patient's anemia.