A 45-year-old male, vegan, presents with fatigue and feeling lightheaded. On examination, there is notable pallor and spoon-shaped nails (koilonychia). What are the potential causes and next steps?
The patient's symptoms and findings, in conjunction with his diet, suggest iron deficiency anemia. The vegan diet may be contributing if he's not eating enough iron-rich plant foods or not adequately absorbing iron. Initial tests should include a CBC and reticulocyte count, followed by iron studies if anemia is confirmed. Dietary counseling regarding iron-rich foods and appropriate supplementation should be considered if iron deficiency is confirmed.