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Differential Diagnosis for a 62-year-old man with decreased hemoglobin and hematocrit and elevated mean corpuscular volume (MCV)

  • Single most likely diagnosis
    • Vitamin B12 or Folate Deficiency: This is a common cause of macrocytic anemia, characterized by a decreased hemoglobin and hematocrit with an elevated MCV. The deficiency can be due to inadequate dietary intake, malabsorption, or increased demand.
  • Other Likely diagnoses
    • Chronic Alcohol Abuse: Alcohol interferes with folate absorption and can lead to macrocytic anemia. Additionally, alcohol can cause liver disease, which can also result in macrocytosis.
    • Hypothyroidism: Some patients with hypothyroidism may develop macrocytic anemia, possibly due to decreased erythropoiesis or altered lipid metabolism.
    • Reticulocytosis: An increase in reticulocytes (immature red blood cells) can cause an elevated MCV. This can be seen in response to anemia, blood loss, or other conditions that stimulate bone marrow production.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Myelodysplastic Syndrome (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells, which can lead to macrocytic anemia. MDS can progress to acute myeloid leukemia if left untreated.
    • Bone Marrow Failure: Conditions such as aplastic anemia or pure red cell aplasia can cause macrocytic anemia due to decreased erythropoiesis.
    • Cancer: Certain types of cancer, such as lymphoma or leukemia, can cause macrocytic anemia due to bone marrow infiltration or suppression.
  • Rare diagnoses
    • Orotic Aciduria: A rare genetic disorder that affects pyrimidine synthesis, leading to macrocytic anemia.
    • Congenital Dyserythropoietic Anemia: A group of rare genetic disorders characterized by ineffective erythropoiesis and macrocytosis.
    • Pernicious Anemia: An autoimmune disorder that causes vitamin B12 deficiency due to impaired absorption, leading to macrocytic anemia.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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