Snap Shot A 28-year-old man presents with chronic diarrhea, arthritis, and microcytic anemia. He has not traveled outside of the United States for the last several years and does not remember eating anything strange. His physical examination is unremarkable aside fom conjuntival pallor and some joint stiffness when he first begins moving after sitting in the waiting room for twenty minutes. His blood smear is shown. Introduction A microcytic anemia Most common anemia worldwide Causes include menstruating state pregnant and lactating woman chronic blood loss colon cancer until proven otherwise in elderly dietary deficiency in children high cow's milk intake in young children Presentation Symptoms fatigue Physical exam tachycardia smooth tongue brittle nails esophageal webs pallor PICA (craving for ice chips) restless leg syndrome Evaluation Elevated TIBC Low serum iron serum ferritin reticulocyte count due to decreased production (no iron to support) Blood smear shows hypochromatic RBCs (doughnut cells) with moderate poikilocytosis Treatment Iron sulfate