Differential Diagnosis for Elevated Ferritin, Low TIBC, Normal Iron, and Low Transferrin
Single Most Likely Diagnosis
- Anemia of Chronic Disease (ACD): This condition is characterized by elevated ferritin levels, low total iron-binding capacity (TIBC), and normal or low serum iron levels. The low transferrin level also supports this diagnosis, as transferrin is often decreased in ACD due to the body's acute phase response, which prioritizes the production of ferritin over transferrin.
Other Likely Diagnoses
- Hemochromatosis: Although less likely given the normal iron levels, hemochromatosis can present with elevated ferritin and low TIBC. However, iron levels are typically elevated, and transferrin saturation is high.
- Chronic Inflammation: Conditions like rheumatoid arthritis can cause an increase in ferritin due to inflammation, decreased TIBC, and variable effects on iron and transferrin levels.
- Obesity: Obesity is associated with chronic inflammation, which can lead to elevated ferritin, decreased TIBC, and alterations in iron and transferrin levels.
Do Not Miss Diagnoses
- Malignancy: Certain cancers can cause elevated ferritin levels due to tumor production or as a paraneoplastic syndrome. It's crucial to rule out malignancy, especially if other symptoms or risk factors are present.
- Sepsis or Severe Infection: In the context of an acute infection, ferritin can be markedly elevated, and TIBC can be low. This scenario would also likely present with other clinical signs of infection.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare but life-threatening condition characterized by excessive immune activation, which can lead to elevated ferritin levels (often very high), and alterations in iron and transferrin due to the disease process.
Rare Diagnoses
- Porphyria Cutanea Tarda: A disorder of porphyrin metabolism that can lead to elevated ferritin levels due to iron overload.
- Hyperferritinemia Cataract Syndrome: A rare genetic disorder causing elevated ferritin levels without iron overload.
- Aceruloplasminemia: A rare genetic disorder characterized by iron accumulation in the brain and other organs, leading to elevated ferritin and low transferrin levels.