Differential Diagnosis for a 68-Year-Old Female with Anemia
Single Most Likely Diagnosis
- Iron Deficiency Anemia: Despite the patient's ferritin level being within a range that might not typically indicate iron deficiency (ferritin 108), the low iron level (13.8) and relatively low transferrin saturation (24%) suggest that iron deficiency could be a contributing factor, especially considering the microcytic anemia indicated by the low MCH (20.1) and the presence of anemia (Hb 8.4). The RDW (16) is slightly elevated, which can be seen in iron deficiency anemia.
Other Likely Diagnoses
- Anemia of Chronic Disease: Given the patient's age and the presence of anemia without clear symptoms of iron deficiency (e.g., no mention of gastrointestinal bleeding), anemia of chronic disease should be considered. The ferritin level is elevated, which can occur in chronic diseases due to inflammation, but the iron level and transferrin saturation are low, which could also be consistent with this diagnosis.
- Chronic Kidney Disease (CKD) Related Anemia: Although renal function is reported as normal, mild CKD might not always present with abnormal renal function tests, especially in early stages. CKD can lead to a normocytic anemia, but given the microcytic indices here, it's less likely unless there's a mixed picture.
Do Not Miss Diagnoses
- Gastrointestinal Bleeding: This is crucial to rule out, especially in a patient with iron deficiency anemia, as it could indicate a serious underlying condition such as a gastrointestinal malignancy. The lack of symptoms does not exclude this possibility.
- Myelodysplastic Syndrome (MDS): Although less common, MDS can present with anemia and has a wide range of laboratory findings. It's a diagnosis that would be critical to identify due to its potential for progression to acute leukemia and the availability of specific treatments.
Rare Diagnoses
- Thalassemia Trait: This could present with microcytic anemia, but the patient's age and lack of family history make this less likely. However, it's not unheard of for thalassemia trait to be diagnosed later in life if it has not caused significant symptoms.
- Sideroblastic Anemia: This is a rare condition characterized by the presence of ringed sideroblasts in the bone marrow and can be congenital or acquired. It might present with microcytic anemia and elevated ferritin levels, but it's much less common than other causes of anemia.