Fatigue Workup in Childbearing Women: Not a Fishing Trip
Fatigue Workup in Childbearing Women: Not a Fishing Trip Four tests. That’s the starting line: CBC, ferritin, TSH, pregnancy test. Not a 30-tube rainbow draw. “I'm just so tired all the time.” It's one of the most common complaints in primary care, and in women of childbearing age, the differential is simultaneously broad and predictable. The temptation is to order everything—a CMP, CBC, iron studies, B12, folate, vitamin D, cortisol, ANA, Lyme, EBV, celiac panel, ferritin, TSH, free T4, testosterone—and hope something lights up. That's not a workup. That's a fishing trip. And fishing trips catch incidental abnormalities that generate more tests, more anxiety, and no answers. This post makes the case for a disciplined, stepwise approach. The Core Four: Start Here, Every Time The First-Line Panel CBC : Anemia is the most common lab-identifiable cause of fatigue in this population. Look at hemoglobin AND MCV (microcytic = iron deficiency until proven otherwise). Ferriti...