Differential Diagnosis for Low Hemoglobin (H) and Hematocrit (Hct) with Normal Iron and Ferritin

• Single Most Likely Diagnosis
  • Anemia of Chronic Disease (ACD): This condition is characterized by a chronic inflammatory state leading to anemia, often with normal iron stores but impaired iron utilization. The presence of normal iron and ferritin levels, along with low H&H, makes ACD a strong consideration, especially in patients with known chronic diseases.
• Other Likely Diagnoses
  • Thalassemia: These genetic disorders affect hemoglobin synthesis, leading to anemia. Some forms, like alpha-thalassemia trait, can present with mild anemia and normal iron studies.
  • Anemia of Chronic Kidney Disease (CKD): CKD can lead to a decrease in erythropoietin production, resulting in anemia. Early stages might not significantly alter iron and ferritin levels.
  • Hemoglobinopathy: Similar to thalassemia, other hemoglobinopathies (e.g., sickle cell trait) might not always present with abnormal iron studies but can cause anemia.
• Do Not Miss Diagnoses
  • Acute Blood Loss: Although iron and ferritin might be normal initially, acute blood loss can lead to significant anemia. It's crucial to identify and treat the source of bleeding promptly.
  • Myelodysplastic Syndromes (MDS): These are a group of disorders caused by poorly formed or dysfunctional blood cells. MDS can present with anemia and normal iron studies, but it requires early detection for appropriate management.
• Rare Diagnoses
  • Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency, which can cause anemia. Iron and ferritin levels are typically normal, but it's less common than other causes of anemia.
  • Pure Red Cell Aplasia: A rare disorder where the bone marrow fails to produce red blood cells, leading to severe anemia. It might present with normal iron and ferritin levels but is much less common than other diagnoses.