Differential Diagnosis for a 63-year-old Female Runner
Single Most Likely Diagnosis
- Iron Deficiency Anemia: Given the patient's low hemoglobin (h/h), elevated red cell distribution width (RDW) of 16, and low mean corpuscular hemoglobin (MCH) of 26.4, iron deficiency anemia is the most likely diagnosis. The patient's age, sex, and history of running (which can lead to increased iron loss) further support this diagnosis.
Other Likely Diagnoses
- Anemia of Chronic Disease: This condition could also present with low hemoglobin and altered iron studies, although the MCH might not be as low as in iron deficiency anemia. Chronic diseases such as rheumatoid arthritis, chronic infections, or malignancies could be underlying causes.
- Thalassemia Trait: Although less likely given the patient's age and presentation, thalassemia trait can cause microcytic anemia with low MCH. However, RDW is often lower in thalassemia trait compared to iron deficiency anemia.
- Chronic Blood Loss: Any source of chronic blood loss (e.g., gastrointestinal bleeding) could lead to iron deficiency anemia over time, presenting similarly to the patient's lab results.
Do Not Miss Diagnoses
- Gastrointestinal Malignancy: Although less common, gastrointestinal malignancies can cause iron deficiency anemia due to chronic blood loss. Given the patient's age, it's crucial not to miss this potentially life-threatening diagnosis.
- Celiac Disease: This autoimmune disorder can lead to malabsorption of iron and other nutrients, resulting in anemia. It's essential to consider celiac disease, especially if the patient has other symptoms like diarrhea or weight loss.
- Colon Cancer: Similar to gastrointestinal malignancy, colon cancer can cause chronic blood loss leading to iron deficiency anemia. Screening for colon cancer is recommended based on age and risk factors.
Rare Diagnoses
- Sideroblastic Anemia: A group of disorders characterized by the accumulation of iron in the mitochondria of red blood cell precursors, leading to microcytic anemia. This diagnosis is less common and might require specific testing for confirmation.
- Pernicious Anemia: An autoimmune disorder leading to vitamin B12 deficiency, which can cause macrocytic anemia. However, given the patient's low MCH, this diagnosis is less likely but should be considered if other tests (like vitamin B12 levels) are abnormal.