Differential Diagnosis for a 65-year-old man with abnormal iron studies
The patient presents with a hemoglobin (Hb) of 174, ferritin of 738, total iron-binding capacity (TIBC) of 54, iron of 8, and saturation of 0.15. These values suggest an abnormality in iron metabolism, with elevated ferritin and low iron saturation being key findings.
Single most likely diagnosis
- Anemia of Chronic Disease (ACD): This condition is characterized by low iron levels, elevated ferritin, and decreased TIBC, which matches the patient's lab results. ACD is often seen in chronic diseases such as infections, malignancies, and autoimmune disorders. The patient's age and elevated ferritin level make ACD a likely diagnosis.
Other Likely diagnoses
- Chronic Kidney Disease (CKD): CKD can lead to anemia and alterations in iron metabolism, including elevated ferritin levels. The patient's low iron saturation and elevated ferritin could be consistent with CKD.
- Inflammatory Conditions: Conditions like rheumatoid arthritis or other chronic inflammatory diseases can cause anemia of chronic disease, leading to similar lab findings.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hemochromatosis: Although the patient's iron saturation is low, which is not typical for hemochromatosis, it's crucial to consider this diagnosis due to the significantly elevated ferritin level. Hemochromatosis can lead to severe organ damage if left untreated.
- Malignancy: Certain malignancies can cause anemia and alterations in iron metabolism. Given the patient's age and abnormal lab results, it's essential to rule out underlying malignancy.
Rare diagnoses
- Ferritinopathy: A rare genetic disorder characterized by elevated ferritin levels without iron overload. This diagnosis would be considered if other causes of elevated ferritin are ruled out.
- Gaucher's Disease: A rare genetic disorder that can cause elevated ferritin levels due to the accumulation of glucocerebroside in cells. Although rare, it should be considered in the differential diagnosis if other tests are inconclusive.