IDA in woman

A 35-year-old woman, presented with complaints of easy fatigue persisting for several months. Currently, 24 weeks pregnant, she had not sought prenatal care or taken any vitamins throughout her pregnancy. The patient also reported an unusual craving for eating ice (pagophagia). There were no other significant complaints, and her family and past medical history were unremarkable. She denied smoking, alcohol consumption, or any illicit drug use. Physical examination revealed pale conjunctiva and mild spooning of nails (koilonychia), both indicative of iron deficiency. Additionally, an II/VI systolic murmur was auscultated at the left lower sternal border. Stool examination ruled out occult blood. Complete blood count (CBC) results showed a hemoglobin (Hg) level of 7.1 gm/dl, hematocrit (Hct) of 23%, and white blood cell (WBC) count of 5,400/mm3 (with a normal differential). Platelet count was within the normal range at 450,000/mm3. The mean corpuscular volume (MCV) was 74 fl, below the normal range of 85-95 fl, indicating microcytic red blood cells. The red cell distribution width (RDW) was elevated at 17.1%, exceeding the normal range of 13-15%.