Differential Diagnosis for Low WBC and HGB with Normal Platelets and HCT
Single Most Likely Diagnosis
- Viral infection: Many viral infections can cause a decrease in white blood cell count (leukopenia) and hemoglobin (HGB) levels due to bone marrow suppression or other mechanisms, while platelet counts may remain normal. Examples include influenza, mononucleosis, and hepatitis.
Other Likely Diagnoses
- Bone marrow failure: Conditions such as aplastic anemia can lead to decreased production of blood cells, including white blood cells and red blood cells, resulting in low WBC and HGB. However, platelet counts can be normal or only mildly affected in early stages.
- Chronic disease: Chronic diseases like chronic kidney disease, liver disease, or chronic infections can lead to anemia (low HGB) and leukopenia due to inflammation, malnutrition, or other mechanisms affecting bone marrow function.
- Medication side effects: Certain medications, including some antibiotics, anticonvulsants, and chemotherapeutic agents, can suppress bone marrow activity, leading to low WBC and HGB counts.
Do Not Miss Diagnoses
- HIV/AIDS: Human immunodeficiency virus (HIV) infection can cause significant immune suppression, leading to low WBC counts, and also affects the bone marrow, potentially causing anemia. Early diagnosis is crucial for treatment and management.
- Leukemia or lymphoma: Although these conditions often present with abnormal platelet counts, early stages or certain types (like hairy cell leukemia) might initially show isolated leukopenia and anemia with normal platelets.
- Sepsis: In the early stages of sepsis, there can be a decrease in WBC and HGB due to the consumption of these cells and the body's inflammatory response, even before the typical increase in WBC count is observed.
Rare Diagnoses
- Congenital bone marrow failure syndromes: Conditions like Fanconi anemia or dyskeratosis congenita are rare and can present with cytopenias, including low WBC and HGB, due to bone marrow failure.
- 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 blood clot formation. It can present with anemia and leukopenia.
- Myelodysplastic syndromes (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells, often leading to low counts of one or more types of blood cells. While more commonly associated with an increase in blast cells, early or certain types of MDS might present with isolated cytopenias.