Differential Diagnosis for a 69 y/o Female with Given Laboratory Values

The patient's laboratory values indicate a potential anemia, given the low hemoglobin (11.9 g/dL) and hematocrit (38.9%) levels. The Mean Corpuscular Hemoglobin Concentration (MCHC) is slightly below the normal range, and the Red Cell Distribution Width (RDW) is elevated, suggesting a variation in red blood cell size. Based on these values, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Iron Deficiency Anemia (IDA): The patient's low hemoglobin, low MCHC, and elevated RDW are consistent with IDA. The RDW is particularly useful as it indicates a significant variation in red blood cell size, a hallmark of IDA due to the gradual depletion of iron stores affecting hemoglobin synthesis and resulting in a mix of normocytic and microcytic red cells.

• Other Likely Diagnoses

  • Anemia of Chronic Disease (ACD): This condition could also present with similar laboratory findings, especially if the patient has an underlying chronic disease. However, ACD typically has a more normocytic anemia and may not always show an elevated RDW as significantly as IDA.
  • Mixed Anemia: Given the patient's age and potential for multiple underlying conditions, a mixed anemia (e.g., combining elements of iron deficiency and vitamin deficiency or chronic disease) is possible.

• Do Not Miss Diagnoses

  • Vitamin Deficiency Anemia (B12 or Folate Deficiency): Although the MCHC is slightly low, which might not typically suggest a macrocytic anemia, it's crucial to rule out vitamin B12 or folate deficiency, as these conditions can have severe neurological consequences if left untreated.
  • Hemolytic Anemia: Although less likely given the information, a hemolytic anemia could present with an elevated RDW and would be critical to diagnose due to its potential severity and the need for specific treatment.

• Rare Diagnoses

  • Sideroblastic Anemia: This is a rare condition characterized by the presence of ringed sideroblasts in the bone marrow, which could potentially present with microcytic, hypochromic anemia and an elevated RDW.
  • Thalassemia: While typically diagnosed earlier in life, some forms of thalassemia could present in adulthood, especially if the patient has a mild form or if there has been a delay in diagnosis. However, this would be less likely given the patient's age and the presentation.