Differential Diagnosis
- Single Most Likely Diagnosis
- Anemia of Chronic Disease (ACD): This is the most likely diagnosis given the mildly low hemoglobin, red blood cells, and hematocrit with a normal reticulocyte count. ACD is often normocytic and can be seen in patients with chronic diseases such as diabetes, arthritis, or chronic infections. The normal TSH and CMP suggest that there is no underlying thyroid or renal disease contributing to the anemia.
- Other Likely Diagnoses
- Iron Deficiency Anemia (IDA) with inadequate iron stores: Although the anemia is normocytic, IDA can present with a normocytic anemia if the iron deficiency is mild. A normal reticulocyte count does not rule out IDA, as it may take some time for the reticulocyte count to increase after iron supplementation.
- Anemia of Renal Disease: Although the CMP is normal, mild renal impairment may not be detected by a single CMP. Anemia of renal disease can be normocytic and may have a normal reticulocyte count.
- Do Not Miss Diagnoses
- Myelodysplastic Syndrome (MDS): This is a group of disorders caused by poorly formed or dysfunctional blood cells. MDS can present with a normocytic anemia and a normal reticulocyte count. Although it is less likely, it is a diagnosis that should not be missed due to its potential for progression to acute leukemia.
- Bone Marrow Failure: Bone marrow failure can present with a normocytic anemia and a normal reticulocyte count. This diagnosis should not be missed, as it can be life-threatening if left untreated.
- Rare Diagnoses
- Sideroblastic Anemia: This is a rare disorder characterized by the accumulation of iron in the mitochondria of red blood cell precursors. It can present with a normocytic anemia and a normal reticulocyte count.
- Pure Red Cell Aplasia: This is a rare disorder characterized by the selective failure of red blood cell production in the bone marrow. It can present with a normocytic anemia and a normal reticulocyte count.