Differential Diagnosis for Low Serum Iron, High Normal Ferritin, and Normal CBC

• Single Most Likely Diagnosis
  • Anemia of Chronic Disease (ACD): This condition is characterized by low serum iron, high or normal ferritin levels, and a normal CBC. ACD is often seen in patients with chronic inflammatory or malignant diseases, where the body's iron is sequestered, making it unavailable for erythropoiesis.
• Other Likely Diagnoses
  • Chronic Kidney Disease (CKD): CKD can lead to a decrease in erythropoietin production, resulting in anemia. While serum iron might be low, ferritin levels can be high due to inflammation or other factors associated with CKD.
  • Inflammatory Conditions: Conditions like rheumatoid arthritis, lupus, or other chronic inflammatory diseases can cause anemia of chronic disease, presenting with low serum iron and high normal ferritin.
• Do Not Miss Diagnoses
  • Hemochromatosis: Although less likely given the low serum iron, some forms of hemochromatosis can present with elevated ferritin levels. Missing this diagnosis could lead to significant morbidity due to iron overload.
  • Thalassemia Minor: Certain types of thalassemia can present with low serum iron and elevated ferritin due to increased iron absorption and storage. This diagnosis is crucial for genetic counseling and management.
• Rare Diagnoses
  • Porphyria Cutanea Tarda: A rare disorder that can lead to increased iron absorption and storage, potentially causing elevated ferritin levels. It's characterized by skin blistering and fragility.
  • Aceruloplasminemia: A rare genetic disorder leading to iron accumulation in the brain and other organs, characterized by low serum iron and high ferritin levels, along with neurological symptoms.