Differential Diagnosis for Left Lower Quadrant Pain, Heavy Periods, and Laboratory Results

Single Most Likely Diagnosis

• Iron Deficiency Anemia with Menstrual Bleeding: The patient's heavy periods, low ferritin level (5), and left lower quadrant pain (possibly related to menstrual cramps or ovulation) support this diagnosis. The low WBC and neutrophil count may be related to chronic blood loss and subsequent anemia.

Other Likely Diagnoses

• Pelvic Inflammatory Disease (PID): Although the WBC count is low, PID can present with lower quadrant pain and heavy or irregular menstrual bleeding. The low neutrophil count might not be typical, but it doesn't rule out PID entirely.
• Ovarian Cysts: These can cause left lower quadrant pain and are associated with menstrual irregularities, including heavy periods. The laboratory results don't directly point to ovarian cysts, but they are a common cause of pelvic pain in women.
• Endometriosis: This condition can cause heavy periods, pelvic pain (including left lower quadrant pain), and is a common cause of chronic pelvic pain in women. The laboratory results provided do not specifically indicate endometriosis, but it remains a plausible diagnosis given the symptoms.

Do Not Miss Diagnoses

• Ectopic Pregnancy: Although less likely given the context of heavy periods, ectopic pregnancy is a life-threatening condition that must be considered in any woman of childbearing age presenting with lower quadrant pain. A pregnancy test should be performed to rule this out.
• Appendicitis: While the pain is in the left lower quadrant and appendicitis typically presents with right lower quadrant pain, atypical presentations can occur. The low WBC and neutrophil count might not support this diagnosis, but appendicitis can be deadly if missed.
• Ovarian Torsion: This is a surgical emergency that can present with sudden onset of pelvic pain. Although the laboratory results do not specifically suggest ovarian torsion, the severity of the condition necessitates its consideration.

Rare Diagnoses

• Leiomyosarcoma (Uterine Sarcoma): This rare malignancy can cause heavy menstrual bleeding and pelvic pain. The low ferritin and anemia could be secondary to chronic blood loss, but this diagnosis would be uncommon.
• Intra-abdominal Lymphoma: Although rare, lymphoma can present with a wide range of symptoms, including abdominal pain and anemia. The low WBC and neutrophil count, along with anemia, might suggest a hematological malignancy, but this would be an uncommon diagnosis given the presentation.