Anemia in a 42-year-old woman

• Medical history: History of mild anemia, never evaluated. No COPD, asthma, or other lung disease. No history of coronary artery disease, hypertension, renal disease, cancer, or diabetes.


• Surgical history: Laparoscopic cholecystectomy 5 years prior.


• Medications: Occasional NSAID for headache or muscle pain.


• Allergies: Seasonal rhinitis, no medication allergies.


• Family history: Mother, age 65, has a history of "low blood count" of uncertain etiology; father, age 68, has type 2 diabetes mellitus that is controlled with diet and exercise.


• Social history: Patient is employed as a primary school teacher and coaches the girls' swimming team. She usually swims a mile or so a day, but lately she has not done so because of her exertional symptoms. She has been a vegetarian for 10 years. She does not drink alcoholic beverages and has never smoked or used recreational drugs. No recent travel. No known exposure to infectious diseases. She is married, and she and her spouse are attempting to conceive. She has an annual flu shot and has had a 2-dose immunization for COVID-19.