Ms. R.N. is a 36 yo Caucasian female who presents in the ED with headache, fatigue, weakness, dizziness, dyspnea, and tachycardia. She is afebrile and denies chest pain and fecal blood. Assessment reveals that her oral mucosa is pink and moist, but her tongue appears smooth. Her conjunctiva are pale. She reports that she has been eating ice frequently, and she says she occasionally craves clay. She reports that she has had fatigue and weakness for several weeks, but it has increased significantly in the last 2-3 days.
Lab results:
RBC 3.3 trillion cells/L
Hgb 7.7g/dL
HCT 28.6%
occult blood (+)
Medical History:
Pica
Fatigue
Vertigo
Epistaxis
Menorrhagia
Surgical History:
Tonsillectomy (1998)
Family History:
Mother (living) – hypertension, postpartum hemorrhage requiring transfusion
Father (deceased) – myocardial infarction
Maternal Grandmother (deceased) – chronic fatigue
Maternal Grandfather (living) – stroke, Type II DM, diabetic neuropathy
Paternal Grandmother (living) – COPD
Paternal Grandfather (living) – COPD, hyperlipidemia
Social History:
Non-smoker
Social drinker (1-2 drinks/week)
No reported drug use
References:
American Society for Hematology. (2019). For patients: Iron-deficiency anemia. https://www.hematology.org/Patients/Anemia/Iron-Deficiency.aspx
Case, S. (2019). Fatigue and anemia: Is it celiac disease? https://shelleycase.com/ironing-out-chronic-fatigue-and-anemia-could-it-be-celiac-disease/