Differential Diagnosis for MCH 26.7, Iron 46, H/H WNL
- Single most likely diagnosis
- Iron deficiency anemia: The patient's iron level is low (46), which is a strong indicator of iron deficiency anemia, despite the mean corpuscular hemoglobin (MCH) being slightly below the normal range and hemoglobin/hematocrit (H/H) being within normal limits (WNL). The low iron level is a key factor in this diagnosis.
- Other Likely diagnoses
- Anemia of chronic disease: This condition can present with low iron levels due to inflammation, which can lead to a decrease in iron availability for erythropoiesis, even if iron stores are adequate. The normal H/H could be seen in early or mild cases.
- Thalassemia trait: Some forms of thalassemia can present with microcytic anemia (low MCH) but with iron levels that are not definitively low. However, the iron level here is low, which might not typically align with thalassemia trait unless there's coexisting iron deficiency.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hemochromatosis with iron deficiency: Although less common, it's crucial to consider conditions where iron overload (hemochromatosis) coexists with iron deficiency anemia, possibly due to bleeding or other losses. This diagnosis is critical due to the potential for severe organ damage if hemochromatosis is left untreated.
- Sideroblastic anemia: A group of disorders characterized by the presence of ringed sideroblasts in the bone marrow, which can lead to variable presentations, including microcytic anemia and abnormal iron studies. This condition can be associated with significant morbidity if not recognized and managed appropriately.
- Rare diagnoses
- Porphyrias: Certain types of porphyria can affect heme synthesis, potentially leading to abnormalities in iron metabolism and anemia. However, these conditions are rare and typically present with other distinctive symptoms.
- Lead poisoning: Can cause microcytic anemia with low MCH and potentially affect iron metabolism, though the iron level here doesn't strongly suggest this diagnosis without other supporting evidence like elevated lead levels.