Differential Diagnosis for Elevated Ferritin, Low TIBC, and Low Normal Iron
- Single most likely diagnosis:
- Anemia of chronic disease (ACD): This condition is characterized by elevated ferritin levels, low total iron-binding capacity (TIBC), and low normal or decreased serum iron levels. The high ferritin in ACD reflects an inflammatory response rather than iron overload.
- Other Likely diagnoses:
- Hemochromatosis: Although less likely given the low normal iron, some forms of hemochromatosis could present with elevated ferritin and low TIBC due to iron overload. However, iron levels are typically high.
- Chronic inflammation: Conditions like rheumatoid arthritis can cause elevated ferritin due to inflammation, and TIBC might be low due to the acute phase response.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Hemophagocytic lymphohistiocytosis (HLH): A rare but life-threatening condition that can present with very high ferritin levels (>10,000 ng/mL), low TIBC, and variable iron levels. Early diagnosis is crucial.
- Sepsis: In severe infections, ferritin can be markedly elevated as part of the acute phase response, and iron levels may be low due to increased uptake by macrophages.
- Rare diagnoses:
- Porphyria cutanea tarda: A disorder of porphyrin metabolism that can lead to elevated ferritin and low TIBC, though it's more commonly associated with skin manifestations and liver disease.
- Dysmetabolic iron overload syndrome: A condition characterized by insulin resistance, obesity, and elevated ferritin, which might present with a low TIBC and variable iron levels.