“I’m Tired”

Chief Complaint

  • 28 year old female presented to the ED with increasing fatigue


  • Fatigue started around 2-3 months ago and it’s progressively worsening. She denies any weakness, shortness of breath, dizziness, lightheadedness, or syncope. Last menstrual period was 2 weeks ago. Denies any heavy menstrual bleeding, denies any gastrointestinal bleeding or bleeding otherwise.
  • Review of systems otherwise negative


  • Type 2 Diabetes Mellitus, insulin-dependent

Family History

  • Non-contributory

Social History

  • Denies any tobacco or illicit drug use. Reports social alcohol consumption.


Temp: 37.2° C, BP: 115/72 mmHg, HR: 84 bpm, RR: 12 rpm, SpO2: 98% on room air

Physical Exam

  • No abnormalities


  • CBC, CMP, PT/INR significant only for a hemoglobin of 7.2
  • MCV is 102
  • Reticulocytes are 1.3%

How would you work this up?

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