Differential Diagnosis for 58 year old female with chronic kidney disease, normocytic anemia, low platelets, high RDW, normal creatinine, normal eGFR, and normal urine microalbumin

• Single most likely diagnosis
  • Chronic Kidney Disease (CKD) with Anemia of Chronic Disease: This is likely due to the patient's known history of CKD, which can cause normocytic anemia due to decreased erythropoietin production, and the presence of high RDW indicating a variation in red blood cell size, which is common in anemia of chronic disease.
• Other Likely diagnoses
  • Iron Deficiency Anemia: Despite normal creatinine and eGFR, iron deficiency can occur due to various reasons such as gastrointestinal bleeding, dietary deficiencies, or increased requirement. The high RDW supports this diagnosis as it indicates a significant variation in red blood cell size, typical of iron deficiency anemia.
  • Thrombocytopenia associated with CKD: CKD can lead to thrombocytopenia due to the uremic environment affecting platelet production and function.
  • Mixed Anemia (Iron Deficiency and Anemia of Chronic Disease): Given the patient's CKD and high RDW, it's possible she has a mixed anemia, where both iron deficiency and anemia of chronic disease coexist.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
  • Myelodysplastic Syndrome (MDS): Although less common, MDS can present with normocytic anemia, thrombocytopenia, and a high RDW. It's crucial to consider this diagnosis due to its potential for progression to acute leukemia and the need for specific treatment.
  • Sepsis or Chronic Infection: Chronic infections or sepsis can cause anemia of chronic disease, and the presence of thrombocytopenia could indicate a more severe infection or a specific type of infection affecting the bone marrow.
  • Hematologic Malignancies (e.g., Leukemia, Lymphoma): These conditions can present with anemia, thrombocytopenia, and elevated RDW. Early detection is critical for effective management.
• Rare diagnoses
  • Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency, which can cause normocytic or macrocytic anemia, but the presence of high RDW might suggest a mix of deficiencies.
  • Bone Marrow Fibrosis: A rare condition that can lead to anemia, thrombocytopenia, and variable RDW due to the replacement of bone marrow with fibrotic tissue.
  • Paroxysmal Nocturnal Hemoglobinuria (PNH): A rare, acquired, life-threatening disease of the blood characterized by the destruction of red blood cells, bone marrow failure, and the potential for thrombosis.