Differential Diagnosis

The patient's presentation suggests a severe anemia with several contributing factors. Here's a categorized differential diagnosis:

• Single most likely diagnosis
  • Iron deficiency anemia: The patient's history of hookworm infestation, which can cause chronic blood loss leading to iron deficiency, combined with a diet poor in micronutrients (polished rice), and symptoms such as pale gums and nailbeds, tachycardia, and a swollen tongue, strongly suggest iron deficiency anemia. The critically low Hb/Hct levels further support this diagnosis.
• Other Likely diagnoses
  • Anemia of chronic disease: Given the patient's recent history of hookworm infestation, it's possible that the patient has an underlying chronic infection or inflammation contributing to anemia.
  • Vitamin deficiency anemia (e.g., vitamin B12 or folate deficiency): Although less likely than iron deficiency, the patient's diet of polished rice may also lead to deficiencies in other micronutrients essential for hematopoiesis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sickle cell disease or other hemoglobinopathies: Although less common, these conditions can cause severe anemia and would be critical to diagnose due to their significant impact on management and prognosis.
  • Severe acute blood loss: Although the patient's history suggests chronic blood loss, it's essential to consider the possibility of an acute bleeding event, especially given the patient's critically low Hb/Hct levels.
• Rare diagnoses
  • Thalassemia: A genetic disorder affecting hemoglobin production, which could present with severe anemia, although it's less likely given the patient's clinical presentation and recent history of hookworm infestation.
  • Other rare causes of anemia, such as congenital disorders of glycosylation or transcobalamin deficiency: These conditions are unlikely but should be considered if the patient's anemia does not respond to treatment for iron deficiency or other common causes.