Differential Diagnosis for 74 year old male with macrocytic anemia and right sided cheek bruising
- Single most likely diagnosis
- Vitamin B12 or folate deficiency: This is the most likely diagnosis given the patient's macrocytic anemia. The bruising could be related to the anemia or a separate issue, but the anemia is the primary concern.
- Other Likely diagnoses
- Medication side effect (e.g. anticoagulant or antiplatelet therapy): Although the patient has normal platelets, certain medications can increase the risk of bruising.
- Trauma: The patient's bruising could be related to a traumatic event, which may be more likely in an elderly patient.
- Liver disease: Liver disease can cause macrocytic anemia and may also lead to coagulopathy, increasing the risk of bruising.
- Do Not Miss diagnoses
- Leukemia (e.g. acute myeloid leukemia): Although less likely, leukemia can cause macrocytic anemia and bruising, and is a potentially life-threatening condition if not diagnosed promptly.
- Myelodysplastic syndrome: This condition can cause macrocytic anemia and may also lead to bruising or bleeding.
- Scurvy (vitamin C deficiency): Scurvy can cause bruising and bleeding, and may be more likely in elderly patients with poor nutrition.
- Rare diagnoses
- Inherited disorders of folate metabolism: These disorders are rare, but can cause macrocytic anemia.
- Pernicious anemia: This is a rare autoimmune disorder that causes vitamin B12 deficiency.
- Gastric cancer: Gastric cancer can cause vitamin B12 deficiency and macrocytic anemia, although this is a less common presentation.