50-Year-Old Female with Fatigue and Shortness of Breath Final Diagnosis: Iron Deficiency Anemia Secondary to Menorrhagia

WHY YOU NEED THIS DOCUMENT: This is the complete, step-by-step i-Human Week #9 case study for the 2026 academic year. It features a 50-year-old African American female (L.M.) who presents with progressive fatigue and dyspnea on exertion over 3 months – a classic presentation that every nursing and NP student must master. The final diagnosis is severe iron deficiency anemia (HgB 8.2 g/dL, ferritin 7 ng/mL, MCV 72 fL) secondary to chronic menorrhagia caused by multiple uterine fibroids (confirmed on transvaginal ultrasound). This document is NOT just a summary – it is a comprehensive clinical breakdown written at an advanced level for i-Human success, HESI MedSurg V2 (2026) exam preparation, and clinical rotations. WHAT YOU WILL FIND INSIDE (25 PAGES OF A+ MATERIAL): 1. Complete Case Overview Patient demographics (age 50, female, height 5'4", weight 155 lbs, BMI 26.6) Chief complaint: "I've been exhausted and can't catch my breath for the past 3 months" Setting: Outpatient primary care clinic (i-Human virtual encounter) 2. Full History of Present Illness (HPI) Onset, location, duration, characterization, aggravating/relieving factors, timing, severity Key positives: menorrhagia (8–10 day periods, changing pads q1-2h, large clots), pagophagia (ice craving), geophagia (dirt craving), orthostatic dizziness, pallor, koilonychia (spoon nails), brittle nails, hair thinning, cold hands/feet Key negatives (ROS): no chest pain, syncope, orthopnea, PND, edema, cough, hemoptysis, fever, chills, melena, hematochezia 3. Past Medical, Surgical, Obstetric History PMH: None significant (no HTN, no DM, no heart disease) PSH: None OB/Gyn: G3P3, perimenopausal, menarche age 12, previously regular cycles, last Pap normal 4. Medications & Allergies Ibuprofen 400–600 mg PRN for menstrual cramps (~6 pills/period) Multivitamin with iron (rarely due to GI upset) NKDA (no known drug allergies) 5. Family History Mother: anemia, heavy periods Sisters: heavy periods, iron deficiency anemia, uterine fibroids (one had myomectomy) Paternal grandmother: colon cancer (age 70) 6. Social History Never smoker, occasional alcohol, administrative assistant, sedentary, low red meat intake, high coffee intake, low vitamin C 7. Complete Physical Examination Orthostatic vital signs: sitting HR 108 / BP 110/68 → standing HR 122 / BP 98/60 (orthostatic hypotension present) General: pale conjunctiva, facial pallor, tired appearance HEENT: pale conjunctiva, pale oral mucosa, smooth pale tongue Cardiovascular: tachycardic, regular; soft II/VI systolic ejection murmur (flow murmur); no S3/S4; JVP normal; PMI non-displaced Respiratory: clear to auscultation bilaterally Abdomen: soft, non-tender, no organomegaly Extremities: koilonychia (spoon nails) bilaterally, cap refill 2–3 sec, no edema Neurologic: intact, gait steady Psychiatric: anxious but alert 8. Complete Diagnostic Data (with Normal Ranges & Interpretations) CBC: HgB 8.2 (severe), Hct 25%, MCV 72 (microcytic), RDW 18.5% (anisocytosis), platelets 480 (reactive thrombocytosis) Iron studies: serum iron 25 (low), TIBC 480 (high), transferrin saturation 5% (very low), ferritin 7 (severely low – depleted stores) Peripheral smear: microcytic, hypochromic RBCs, anisocytosis, poikilocytes, absent iron stores Other labs: B12 450 (normal), folate 12 (normal), TSH 2.1 (normal), CMP normal, stool guaiac negative ×2, UA normal Transvaginal ultrasound: uterus enlarged (10 cm), multiple fibroids (3 intramural: 3.2 cm, 4.1 cm; 1 subserosal: 2.5 cm), endometrium 12 mm Chest X-ray: normal ECG: sinus tachycardia (108 bpm), normal axis, no ST-T changes Endometrial biopsy: benign proliferative endometrium