Pale Priscilla — Iron Deficiency Anemia
Fatigue, pallor, spoon nails, pica — low hemoglobin, low ferritin
Priscilla is 24 and exhausted no matter how much she sleeps. Her nail beds are pale and curved upward like little spoons, and she admits she has been chewing ice constantly for weeks.
Priscilla has heavy menstrual periods and a diet low in iron-rich foods, a combination that has slowly drained her iron stores. Iron deficiency anemia develops gradually, so fatigue and pallor creep in before anyone notices. Classic clues include brittle, spoon-shaped nails (koilonychia), a smooth sore tongue (glossitis), and pica — cravings to eat ice, dirt, or starch. Oral iron is first-line, taken with vitamin C on an empty stomach when tolerated, and stools will turn dark green-black.
Read Pale Priscilla's full story →The story arc
The setup
Priscilla has had heavy periods for years and eats mostly processed food with little meat, iron-fortified cereal, or leafy greens.
The turn
She becomes short of breath climbing stairs and needs a nap most afternoons, chalking it up to stress at work.
The crisis
Her nails have become brittle and spoon-shaped, her tongue is smooth and sore, and she confesses to craving ice constantly. Hemoglobin is 8.9 g/dL, ferritin is 6 ng/mL.
The save
Oral ferrous sulfate is started with orange juice to boost absorption, taken between meals when tolerated, and Priscilla is taught that her stools will turn dark and that follow-up labs will track her hemoglobin response.
NCLEX study section — Iron Deficiency Anemia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Health Assessment
Take this chapter into practice questions on the same topic.