What is the cause of my iron deficiency anemia (low serum iron level of 5.70 µmol/L) with normal ferritin (35.33 ng/mL) and folate (4.81 ng/mL) levels, accompanied by symptoms of fatigue, tinnitus, dizziness, hair loss, and decreased appetite, despite normal hemoglobin (14.1 g/dL), alanine transaminase (ALT), aspartate transaminase (AST), and thyroid function?

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Differential Diagnosis

  • Single most likely diagnosis:
    • Iron deficiency anemia: The patient's low serum iron level (5.70 µmol/L) and low MCV (78.7 fL) and MCH (25.9 pg) values, which indicate microcytic hypochromic anemia, are consistent with iron deficiency anemia. The patient's symptoms, such as fatigue, dizziness, and hair loss, also support this diagnosis. The improvement in symptoms after consuming iron-rich foods further suggests iron deficiency anemia.
  • Other Likely diagnoses:
    • Chronic inflammation: The patient's elevated WBC count (11.5 tys/µl) and slightly elevated OB (31 mm/h) may indicate chronic inflammation, which can lead to anemia of chronic disease. However, the patient's normal ferritin level (35.33 ng/mL) and normal hemoglobin level (14.1 g/dL) make this diagnosis less likely.
    • Vitamin deficiency: The patient's low appetite and limited food intake may lead to deficiencies in other essential nutrients, such as vitamin B12 or folate. However, the patient's normal folate level (4.81 ng/mL) and lack of other symptoms suggestive of vitamin B12 deficiency make this diagnosis less likely.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
    • Celiac disease: This autoimmune disorder can cause malabsorption of iron and other essential nutrients, leading to anemia and other symptoms. Although the patient's symptoms are not typical of celiac disease, it is essential to consider this diagnosis due to its potential severity.
    • Gastrointestinal bleeding: The patient's iron deficiency anemia could be caused by chronic gastrointestinal bleeding, which may be asymptomatic. It is crucial to investigate this possibility, as untreated gastrointestinal bleeding can lead to severe complications.
  • Rare diagnoses:
    • Hemochromatosis: Although the patient's ferritin level is normal, it is essential to consider hemochromatosis, a genetic disorder that can cause iron overload. However, the patient's low serum iron level and lack of other symptoms suggestive of hemochromatosis make this diagnosis unlikely.
    • Thalassemia: This genetic disorder can cause microcytic anemia, but the patient's normal hemoglobin level and lack of other symptoms suggestive of thalassemia make this diagnosis unlikely.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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