Iron Deficiency Anemia

Patient Presentation
A 17 year old female, HEU, with no significant past medical history presents to the office complaining of general fatigue, weakness, shortness of breath on exertion, and the occasional headache. She reports that the symptoms began about a month ago, starting with the fatigue and weakness. She comes in today because her soccer coach noticed that she was “playing sluggishly” and thought she might be getting sick. She reports getting 6-8 hours of sleep a night and denies any recent illness such as a cold or flu. She reports eating 3 meals each day and follows a strict vegetarian diet, which she began 3 months ago. When asked about the change in diet, she states that her friend told her it was healthier so they are doing it together. She denies unintentional weight gain or loss, nausea, vomiting, diarrhea or any GI upset. On physical exam, HEU appears pale, but otherwise healthy.

Differentials List
Iron deficiency anemia , B-12 deficiency anemia (pernicious anemia), Anorexia nervosa/Malnutrition, Hemorrhagic anemia from heavy menses, Mono

Diagnosis
HEU denies heavy menses
HEU denies ever having these symptoms before
Height and weight taken to determine BMI – Ht 5’8, Wt 132, BMI 20.1
Blood drawn for a CBC and Monospot - Monospot was negative
WBC 5,500 cells per cubic millimeter
RBC 4.8 million cells per microliter – Hgb 8g/dL, Hct was 26%
Microscopic examination of RBCs shows microcytic, hypochromic RBCs

HEU is diagnosed with iron deficiency anemia

Treatment
Fist line of treatment focuses on pt education and dietary counseling. HEU’s anemia is a new-onset condition and she does not show any signs of further complications, such as cardiac problems. She does not require medication or treatment, but rather she needs simple guidance regarding dietary iron sources outside of the animal kingdom. Initial instruction is given pertaining to plant-based sources of iron such as dark leafy greens, legumes and soybeans along with the importance of pairing such foods with vitamin C for maximum absorption. HEU is referred to a dietitian for further counseling. Additionally, over the counter supplemental iron is recommended for HEU while she learns to incorporate natural food-based sources of the mineral into her diet, along with a daily multivitamin.

Case created by Hannah Underdahl, 2011.