Signal Sprint 02: The Number That Changes the Visit

Stress, inadequate sleep, and inconsistent nutrition

Iron-deficiency anemia or another hematologic process

Reassure the patient and recommend sleep, hydration, and more regular meals

Obtain focused history and examination, including menstrual and bleeding history, and order or perform appropriate initial testing

Start an antidepressant for possible stress-related symptoms

Schedule a routine follow-up visit in 3 months

The absence of fever or recent respiratory symptoms

A point-of-care hemoglobin of 7.8 g/dL with exertional palpitations and lightheadedness

Her report of occasionally skipping breakfast

Which finding most meaningfully changes the interpretation of this visit?

Continue lifestyle counseling and recheck a CBC at the next annual visit

Treat this as symptomatic anemia requiring focused same-day assessment, evaluation of the likely bleeding source, and disposition based on stability and symptoms

Recommend an over-the-counter multivitamin and routine gynecology follow-up in several months

Attribute the symptoms to anxiety because oxygen saturation is normal