A 42-year-old woman comes to the office for evaluation of significant anemia. She was diagnosed the previous week at an urgent care center during an evaluation for a 2-week history of progressive fatigue and dyspnea on exertion. She had a negative workup for cardiac and pulmonary disease, including normal pulse oximetry, chest x-ray, ECG, and point-of-care cardiac ultrasound. However, at that visit her hemoglobin was discovered to be 7.0 gm/dL (70 gm/L). Today in the office, she is still dyspneic with exertion, is unable to climb a flight of stairs without stopping, but she denies any other current symptoms. She has noted no bloody or dark stools or excessive vaginal bleeding. Her menses are regular, lasting 4 days, and she describes them as "not heavy." She has been told in the past that she had a "low blood count" that her previous doctor attributed to her periods and her vegetarian diet. She was sometimes treated with iron supplements but has had no other treatment or workup.
She brings her CBC results from the urgent care center:
| Hemoglobin (g/dL) |
7.2 |
| Hematocrit (%) |
21.6 |
| RBC (million/cm3) |
3.5 |
| WBC/ mm3 |
7500 |
| Differential (%) |
|
| Polys |
75 |
| Bands |
4 |
| Lymphs |
15 |
| Monos |
4 |
| Eosinophils |
2 |
| MCH (pg/cell) |
30 |
| MCV (fL) |
89 |
| MCHC % |
39 |
| RDW |
13 |
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