Differential Diagnosis for Anemia in a 42-year-old Female

Based on the provided CBC and iron studies, the following differential diagnoses are considered:

• Single most likely diagnosis

  • Iron Deficiency Anemia (IDA): The patient's low iron level (11 μg/dL), low transferrin saturation (3%), and low ferritin (4 µg/L) are all indicative of iron deficiency anemia. The microcytic anemia (low MCV of 66.5 fL) and low MCH and MCHC values further support this diagnosis.

• Other Likely diagnoses

  • Chronic Disease Anemia: Although the primary indicators point towards IDA, chronic disease anemia could also present with low iron and ferritin levels due to inflammation. However, the lack of elevated WBC or other markers of chronic disease makes this less likely.
  • Thalassemia Trait: This could be considered due to the microcytic anemia. However, the RDW is not as elevated as typically seen in thalassemia trait, and other specific tests (like hemoglobin electrophoresis) would be needed to confirm this diagnosis.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Gastrointestinal Bleeding: A source of chronic blood loss could lead to iron deficiency anemia. Identifying and treating the source of bleeding is crucial to prevent further complications.
  • Celiac Disease: This autoimmune disorder can lead to malabsorption of iron and other nutrients, resulting in anemia. It's essential to consider this in the differential diagnosis, especially if the patient has other symptoms like diarrhea or abdominal pain.
  • Colon Cancer: Although less common in a 42-year-old, any source of chronic blood loss, including colon cancer, needs to be considered and ruled out, especially if there are other symptoms like weight loss or changes in bowel habits.

• Rare diagnoses

  • Sideroblastic Anemia: A group of disorders characterized by the accumulation of iron in the mitochondria of red blood cell precursors. This could present with microcytic anemia and low serum iron but is less common.
  • Anemia of Chronic Kidney Disease: Although the patient's iron studies suggest iron deficiency, anemia can also occur in chronic kidney disease due to decreased erythropoietin production. However, without other indicators of kidney disease, this is less likely.