What is the most likely cause of anemia in a 72-year-old male with a history of hypertension and chronic atrial fibrillation (AF), presenting with normocytic anemia, as indicated by a hemoglobin level of 11.1 g/dL and a mean corpuscular volume (MCV) of 104 fL?

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Last updated: April 21, 2025 • View editorial policy

Differential Diagnosis for Anemia in a 72-year-old Male

Single most likely diagnosis

  • Chronic Blood Loss: Given the patient's age and history of hypertension and chronic atrial fibrillation, chronic blood loss from gastrointestinal sources (e.g., ulcers, angiodysplasia, or malignancies) is a common cause of anemia, especially with a mean corpuscular volume (MCV) of 104 indicating macrocytic anemia. The elevated MCV could also suggest a component of folate or vitamin B12 deficiency, which can be associated with chronic diseases or dietary deficiencies in the elderly.

Other Likely diagnoses

  • Folate or Vitamin B12 Deficiency: These deficiencies can lead to macrocytic anemia and are common in the elderly due to dietary deficiencies, malabsorption, or increased demand. The patient's MCV of 104 supports this possibility.
  • Chronic Kidney Disease (CKD): Although not directly indicated by the information provided, CKD is common in patients with hypertension and can cause anemia. However, CKD typically results in a normocytic anemia, making it less likely given the patient's macrocytic indices.
  • Anemia of Chronic Disease: This condition is associated with chronic infections, inflammation, or malignancy. While the patient's recent diagnosis of non-cardiac chest pain and history of atrial fibrillation do not directly point to a chronic inflammatory condition, it remains a consideration, especially if the anemia is normocytic.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Gastrointestinal Malignancy: Although less common, gastrointestinal malignancies can cause chronic blood loss leading to anemia. Given the patient's age, this is a critical diagnosis not to miss.
  • Hemorrhagic Disorder: Bleeding disorders, such as hemophilia or von Willebrand disease, are rare but critical to diagnose, especially if the patient has a history of easy bruising or prolonged bleeding after minor injuries.

Rare diagnoses

  • Myeloproliferative Neoplasms: Conditions like polycythemia vera, essential thrombocythemia, or primary myelofibrosis can sometimes present with anemia, especially in advanced stages or with associated splenomegaly. However, these are less common and typically have other distinguishing features.
  • Pernicious Anemia: An autoimmune condition leading to vitamin B12 deficiency due to lack of intrinsic factor. It's less common but should be considered in the differential for macrocytic anemia, especially if other causes are ruled out.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.