Differential Diagnosis for a 15-year-old boy with fatigue and abnormal iron studies
Single most likely diagnosis
- Iron Deficiency Anemia: The patient's low ferritin level (47.8) and high TIBC (288) are indicative of iron deficiency anemia, which is a common cause of fatigue. The transferrin percentage is also low (40), further supporting this diagnosis.
Other Likely diagnoses
- Anemia of Chronic Disease: Although the ferritin level is low, the patient's high total leukocyte count (3,990) and low hemoglobin (14.2) could suggest an underlying chronic disease process. However, the lack of other specific markers or symptoms makes this less likely than iron deficiency anemia.
- Nutritional Deficiencies: The patient's fatigue and anemia could be related to nutritional deficiencies, such as vitamin B12 or folate deficiency, although the provided lab values do not directly support this diagnosis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hemoglobinopathy or Thalassemia: Although less likely, these conditions can cause anemia and fatigue. A hemoglobin electrophoresis or genetic testing would be necessary to rule out these conditions.
- Leukemia or Lymphoma: The patient's elevated total leukocyte count (3,990) could be a sign of a hematologic malignancy, although the differential count does not show a significant left shift or blasts.
- Chronic Infection or Inflammation: The patient's elevated leukocyte count could also indicate a chronic infection or inflammatory process, which could be causing the anemia and fatigue.
Rare diagnoses
- Transferrinemia or Atransferrinemia: These rare genetic disorders affect transferrin production and can cause anemia and fatigue. However, the patient's transferrin level (246) is within normal limits, making this diagnosis unlikely.
- Sideroblastic Anemia: This rare condition is characterized by abnormal iron metabolism and can cause anemia and fatigue. However, the patient's lab values do not specifically support this diagnosis.