What causes extreme tiredness in a 17-year-old?

Question

Hello doctor,

My 17-year-old daughter has been extremely tired lately. She recently had her bloodwork done, and the following results were flagged: Ferritin 8 ng/mL, RDW (red cell distribution width) 12.2 percent, MPV (mean platelet volume) 6.7 fL, neutrophils 73 percent, and lymphocytes 21 percent.

I am concerned that her low ferritin levels might be contributing to her fatigue. She also struggles with OCD and anxiety, for which she takes Lexapro (Escitalopram) 10 mg nightly. She is also on Ferrous sulfate (325 mg) three times a week.

Could we get your opinion on these results?

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

Thank you for choosing us as your healthcare provider.

I have gone through all your details and appreciate your concern.

Hoping your daughter is doing fine. Yes, the tiredness could be due to low ferritin levels. Although her serum iron is fine, it means that her iron is not sufficient to be stored and used by the body. Another helpful aspect to consider is her eating and sleeping habits. Sometimes, diarrhea and stomach issues can cause low ferritin levels due to malabsorption. If she does not have foul-smelling stool or signs of malabsorption, that is good. But if she does, she should get checked, as some malabsorption issues, like celiac disease, can also cause depression and anxiety, along with weakness.

Given that her weight is also low for her height, the treatment plan should consider all her symptoms. One thing you could try is increasing her iron supplements. She is currently taking a low dose on alternate days. If it does not harm her, she could take ferrous sulfate daily and then repeat the ferritin test after a month.

Another thing to consider is consulting her psychiatrist again because sometimes depression can manifest as tiredness. I would also recommend starting her on B12 and folate supplements. Sometimes, low calcium levels can cause bone pain. If that is the case, she might benefit from consuming more milk and dairy products.

A better diet is key to her health, along with better sleep. Encourage her to eat fruits and vegetables rich in iron, nuts, milk, and red meat. A balanced diet, good sleep, and regular exercise will help, along with the supplements I mentioned earlier. Take these steps and repeat her ferritin levels after a month.

I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.

Thank you.