Differential Diagnosis

The patient's laboratory results indicate abnormalities in iron and copper levels, as well as an elevated RDW (Red Cell Distribution Width), which suggests a variation in red blood cell size. This can be indicative of several conditions affecting the blood and iron metabolism. Here's a categorized differential diagnosis based on the provided information:

• Single Most Likely Diagnosis

  • Iron Deficiency Anemia: The patient has low iron levels (75) and ferritin (61), which are key indicators of iron deficiency. The transferrin saturation is also low at 31%, further supporting this diagnosis. Iron deficiency anemia is characterized by low iron stores, which can lead to smaller and more varied red blood cells, explaining the elevated RDW.

• Other Likely Diagnoses

  • Anemia of Chronic Disease: This condition can also present with low iron levels and elevated ferritin due to the body's inflammatory response. However, the ferritin level here is not significantly elevated as typically seen in anemia of chronic disease, making it less likely.
  • Copper Deficiency: The low copper level (67) could suggest a deficiency, which can also affect hematopoiesis and lead to anemia. However, copper deficiency is less common and typically presents with neurological symptoms as well.

• Do Not Miss Diagnoses

  • Hemochromatosis: Although the iron and ferritin levels are low, which does not typically suggest hemochromatosis (a condition of iron overload), it's crucial to consider genetic hemochromatosis, especially if there's a family history. Early diagnosis can prevent significant organ damage.
  • Wilson's Disease: This is a genetic disorder leading to copper accumulation in the body. Although the copper level is low, Wilson's disease can present with a wide range of copper levels, and it's critical to diagnose early to prevent liver and neurological damage.

• Rare Diagnoses

  • Aceruloplasminemia: A rare genetic disorder characterized by iron accumulation in the brain and other organs due to a lack of ceruloplasmin, a protein that carries copper in the blood. It could potentially explain the low copper level and anemia.
  • Transferrinemia: A rare condition involving defects in the transferrin protein, which is crucial for iron transport. This could potentially explain the low iron levels and elevated transferrin saturation in some cases, although the saturation here is actually low.