Description

Vanessa Rivas is a 50-year-old female presenting with several months of progressive fatigue, exertional dyspnea, and lightheadedness. She experienced a near-syncopal episode today while gardening that prompted evaluation. Her symptoms worsen with physical activity and are accompanied by new-onset headaches. Physical examination reveals pallor, mild conjunctival pallor, angular cheilitis, and orthostatic hypotension. She reports significantly heavy menstrual periods over the past 10-12 months, requiring frequent tampon changes, and has followed a strict vegan diet for two years. Her symptom constellation—fatigue unrelieved by rest, exertional dyspnea, lightheadedness, pallor, heavy menses, and dietary restrictions—strongly suggests iron deficiency anemia.