Differential Diagnosis for Anemia in a 72-year-old Male
Single Most Likely Diagnosis
- Anemia of Chronic Disease: Given the patient's history of hypertension and chronic atrial fibrillation, along with a recent episode of non-cardiac chest pain, anemia of chronic disease is a plausible diagnosis. The slightly low hemoglobin level and elevated MCV could be consistent with this condition, especially if there's an underlying chronic inflammatory process.
Other Likely Diagnoses
- Vitamin Deficiency Anemia (Folate Deficiency): Although the Vitamin B12 level is normal, the MCV of 104 suggests a macrocytic anemia. Folate deficiency could be a cause, especially if the patient's diet is lacking or if there's malabsorption.
- Chronic Blood Loss: Given the patient's age and potential for gastrointestinal issues, chronic blood loss could lead to iron deficiency anemia, which might not be immediately apparent from the initial lab values but could contribute to the anemia.
Do Not Miss Diagnoses
- Myelodysplastic Syndrome (MDS): Although less common, MDS is a condition that can cause anemia and has a higher incidence in older adults. It's crucial to consider this diagnosis to avoid missing a potentially treatable condition.
- Gastric Cancer: Chronic blood loss from gastric cancer could lead to anemia. Given the patient's age, this is a diagnosis that should not be missed, as early detection significantly improves outcomes.
Rare Diagnoses
- Pernicious Anemia: An autoimmune condition leading to Vitamin B12 deficiency, which is less likely given the normal Vitamin B12 level but could be considered if other causes are ruled out and the patient has specific autoimmune antibodies.
- Bone Marrow Failure Syndromes: Conditions like aplastic anemia or pure red cell aplasia are rare but could cause anemia. These would typically have more profound effects on the blood counts and might be suggested by specific findings on the peripheral smear or bone marrow biopsy.