A common complaint
The patient reported low energy, reduced exercise tolerance and occasional palpitations. Work stress and poor sleep seemed sufficient explanations.
The quiet physical clues
Conjunctival pallor and a soft flow murmur prompted a complete blood count. The haemoglobin was substantially reduced.
The twist
Iron-deficiency anaemia was confirmed, and the next question became why iron had been lost—not simply how to replace it.
Take-home message
Fatigue is nonspecific. Examination and a basic differential matter. When iron deficiency is diagnosed, identify the underlying cause rather than repeatedly prescribing iron alone.
Diagnostic principle: do not let the first plausible label stop the search when an important detail does not fit.
Educational note: This is a teaching composite, not a substitute for patient-specific diagnosis or treatment. Real patients require direct clinical assessment and appropriate investigations.