Answer :
Differential diagnoses for a 59-year-old female with fatigue include Iron Deficiency Anemia, Vitamin B12 Deficiency Anemia, and Hypothyroidism. Common lab results and symptoms help distinguish these conditions. Alternative diagnoses would vary based on age and pregnancy status.
1. Differential Diagnosis
- Iron Deficiency Anemia
- Vitamin B12 Deficiency Anemia
- Hypothyroidism
2. Explain Each Diagnosis
- Iron Deficiency Anemia: The patient has low hemoglobin (9.6), low RBC (3.2), low MCV (70), low MCH (22), low ferritin (9), and low iron (20), consistent with iron deficiency anemia. The gradual onset of fatigue and pallor is common.
- Vitamin B12 Deficiency Anemia: The patient's B12 level is less than 200, which is below normal, indicating B12 deficiency. Symptoms such as increased fatigue and impaired concentration fit this diagnosis.
- Hypothyroidism: Even though not explicitly measured here, hypothyroidism can cause fatigue, weight gain, and dry skin, which some of the symptoms pointing towards hypothyroidism.
3. Pathophysiology Flow Chart
Iron Deficiency Anemia:
Insufficient iron → Decreased hemoglobin production → Decreased oxygen delivery → Fatigue
Vitamin B12 Deficiency Anemia:
Deficient B12 intake/absorption → Impaired DNA synthesis in RBCs → Megaloblastic anemia → Fatigue
Comparison:
- Both conditions involve anemia leading to reduced oxygen delivery to tissues, resulting in fatigue.
- Symptoms overlap: fatigue, pallor, and possibly occasional shortness of breath.
- Differences include specific lab values (i.e., low MCV in iron deficiency vs. high MCV in B12 deficiency).
4. Differential Diagnoses for Different Ages
- If the patient were 79 years old, differential diagnoses could include Parkinson's Disease, Heart Failure, or Chronic Kidney Disease.
- If the patient were a 25-year-old pregnant woman, differential diagnoses could include Gestational Diabetes, Anemia of Pregnancy, or Thyroid Disease.