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 was ready in 2 hours. 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 costing takes 2 hours and gives the answer.
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. It takes 2 hours and may find an anaemia that iron tablets will fix within 3 months.
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