Blue sclera: An overlooked finding of iron deficiency

Abstract

A 46-year-old woman presented with a 3-month history of progressive fatigue and shortness of breath. She had a history of uterine fibroids with heavy menstrual bleeding but had missed her gynecologic follow-up examination 2 years earlier. Physical examination revealed facial and conjunctival rim pallor, blue sclera (Figure 1A) with conjunctival rim pallor, and koilonychia. Laboratory tests were hemoglobin 4.0 g/dL (reference range 12–16), hematocrit 16.7% (37–47), mean corpuscular volume 54.8 fL (80–98), serum ferritin 0.8 ng/mL (24–307), and transferrin saturation 2.8% (20%–50%). Iron deficiency anemia was diagnosed