Question

patient with history of Rheumatoid Arthritis feeling tachycardia and shortness of breath go to clinician, and did lab tests and found:

Reticulocytes count was low

ESR high

CRP high

liver function test (LFT) and (RFT) are normal

serum iron normal

transferrin normal

ferritin high

------------

hemoglobin is 8.0 g/dl

Mcv and MCH are normal

>>>>>>>>>>>>>>>>>>>>

what is the provisional diagnosis? and why?

what are the differential diagnosis (DD)? what further test needed to distinguish between DD?

Answer 1

Provisional diagnosis:

Rheumatoid arthritis related anaemia of chronic disease.

Because:

The ESR and CRP levels are high.

Serum iron levels are normal and ferritin levels are high.

Haemoglobin levels are less than normal physiological value.

And also reticulocytes levels are low.

And tachycardia and shortness of breath is seen.

Differential diagnosis(DD):

Infection and malignancy also cause high CRP and ESR levels which has to be ruled out.

Throat culture remains the standard for confirmation of group A streptococcal infection.

Blood cultures are useful to rule out infective endocarditis.

• ASO test(Anti-streptolysin-O) is used to detect streptococcal antibodies directed against streptococcal lysin O.An elevated titer is a proof of a previous streptococcal infection.
• These tests are non specific,but they are very useful in monitoring disease activity.