Chioma had been exhausted for 6 months. She assumed it was final-year stress. A friend commented that she looked pale. A full blood count at Mascot Healthcare found her haemoglobin at 7.8 g/dL — severely low. Iron tablets and dietary advice had her haemoglobin at 11.4 g/dL within 3 months.
Final-year student, UNILAG. Presented with 6-month history of fatigue, difficulty concentrating, exertional breathlessness on stairs, and pallor noticed by a friend. Haemoglobin on FBC: 7.8 g/dL (normal: ≥ 12.0 g/dL). MCV 62 fL — microcytic. Ferritin: 6 ng/mL. Iron-deficiency anaemia confirmed.
Full Blood Count (FBC)Chioma had attributed every symptom to her final-year project deadline. The fatigue — she was studying late. The difficulty concentrating — the pressure was enormous. The breathlessness climbing the three floors to her department — she had stopped going to the gym. When her roommate said, "Chioma, you look really pale," she had checked a mirror. She did look pale. But finals were in 6 weeks.
It was not her roommate who finally got her to come in — it was a fainting episode in the library on a Tuesday afternoon. She had stood up too quickly from a reading desk and blacked out briefly. A librarian had helped her. She sat for 20 minutes before she felt able to walk. She came to Mascot Healthcare that afternoon.
The FBC result came back quickly. The doctor reviewed it carefully: Hb 7.8 g/dL — severe anaemia. MCV 62 — microcytic. The blood film showed hypochromic, microcytic red cells — the classic appearance of iron deficiency. Ferritin 6 ng/mL confirmed the cause.
A full blood count (FBC) is the most commonly requested blood test — it measures the three main cell types in blood and multiple derived indices that together reflect nutritional status, infection, bone marrow function, and inflammation.
The oxygen-carrying protein in red blood cells. Low Hb = anaemia. Severity: mild (10–11.9 g/dL), moderate (8–9.9), severe (< 8). Chioma's: 7.8 g/dL.
Size of red blood cells. Low MCV = microcytic anaemia (iron deficiency, thalassaemia). High MCV = macrocytic (B12/folate deficiency). Chioma's: 62 fL (low).
Detects infection (elevated WBC), immune suppression (low WBC), or leukaemia (very high WBC with abnormal differential).
Low platelets = bleeding risk (thrombocytopenia). High platelets = reactive (infection, iron deficiency) or clotting risk.
Stored iron — the most sensitive test for iron-deficiency anaemia. Chioma's: 6 ng/mL (severely depleted; normal > 12, optimal > 50 for women).
The fatigue, the pallor, the exertional breathlessness, the difficulty concentrating — every one of Chioma's symptoms was a direct consequence of her haemoglobin being half the normal level. With haemoglobin at 7.8 g/dL, her blood was carrying less than two-thirds of the oxygen her body needed. Her brain and muscles were running on a reduced oxygen supply every day for months.
The cause was identifiable: heavy menstrual blood loss (she reported soaking 6–8 pads per day on her heaviest days, a fact she had normalised as "just how my periods are"), combined with a diet low in red meat and iron-rich foods. The anaemia had been building for months and was fully correctable.
An oral iron supplement (taken with orange juice for absorption) was prescribed — the standard replacement for severe iron-deficiency anaemia. A vitamin C supplement with each dose to enhance absorption. Dietary counselling: increase red meat, beans, dark leafy greens; reduce tea and coffee with meals (tannins inhibit iron absorption).
The menorrhagia was addressed: a pelvic scan was arranged (result: no fibroids; cycle was heavy functional). A medication was prescribed for use on heavy days to reduce blood loss. A long-term contraceptive option (a hormonal IUD) was discussed as a way to reduce blood loss and allow iron stores to recover.
Chioma was told: haemoglobin should rise by approximately 1 g/dL per week on oral iron. She should feel measurably better within 2–3 weeks. A repeat FBC was booked for 6 weeks.
Hb 7.8 g/dL, MCV 62 fL, ferritin 6 ng/mL — severe iron-deficiency anaemia. Cause: heavy menstrual losses + low dietary iron.
An oral iron supplement + vitamin C; dietary iron counselling; medication to reduce heavy menstrual bleeding; pelvic scan arranged; repeat FBC at 6 weeks.
FBC at 6 weeks: Hb 10.2 g/dL (improving). At 3 months: Hb 11.4 g/dL, ferritin 24 ng/mL. Chioma completed her finals with improving energy. Target Hb 12.0+ at 6 months.
Haemoglobin 11.8 g/dL at 6 months — near-normal. Ferritin 38 ng/mL (building). Chioma graduated, passed her final exams, and no longer faints. She understands her menstrual blood loss needs ongoing monitoring.
Fatigue, pallor, and breathlessness in a young woman with heavy periods is anaemia until proven otherwise. It is not stress, not fitness, not "just how she is." A full blood count is affordable and gives the answer quickly.
Iron-deficiency anaemia from heavy periods is extremely common and entirely correctable. Oral iron tablets work — but the menstrual blood loss that caused the anaemia also needs to be addressed, or the anaemia will recur.
If you're always tired, pale, and breathless climbing stairs — get a full blood count. Results come back quickly and may find an anaemia that iron tablets will fix within 3 months.
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