A 38 year old woman with no prior psychiatric or medical history presents with a craving for toothpaste for the past 4 months. She admits that this has got out of control of late, and that she now ingests approximately 5 tubes of toothpaste each week. She also complains of being easily fatigued during the last year, but attributed this to her busy life as a working mother of three, with her youngest child (3 years old) still being breastfed. Upon further questioning, she reveals that she follows a vegetarian diet and is often very "picky" when it comes to food. She also confesses to a habit of biting and consuming her nails, which was first noticed towards the latter half of her second pregnancy. Her gynecological and family histories are unremarkable. She drinks only socially and does not smoke. A urine pregnancy test is negative.
WBC: 5.4 x 10^9/L (4- 11× 10^9) Neutrophils: 73% (50-70) Lymphocytes: 24% (20-40) Hb: 6.3 g/dL (11.5-13.5) RBC: 2.3 x 10^12/L (4.0-5.4 × 10^12) HCT: 23.1% (38- 46) MCV: 59 fL (80-100) MCH: 16.1 pg/cell (27-31) MCHC: 27.2 g/dL (32-36) RDW: 15.1% (11.6-14.6) Platelets: 501 x 10^9/L (150-450 × 10^9) Reticulocytes: 0.7% (0.2-2)
The peripheral blood film demonstrates hypochromic microcytic red cells, and anisopoikilocytosis.
Serum Iron: 3 mmol/L (14-32) Serum Transferrin: 3.9 g/L (2.0- 3.6) Serum Ferritin: 7 ng/mL (40-260) Transferrin Saturation: 8% (20- 50)
You realize that a bone marrow examination is probably not indicated right now.