A 7-year-old male with pallor and abdominal discomfort

A 7-year-old male was brought with complaints of persistent fatigue, lethargy, evident pallor and abdominal discomfort since past two months. His mother reports he is less active than usual and prefers to stay indoors. He experiences occasional dizziness and shortness of breath during physical activities. A decline in academic performance is also observed in this child. His past medical history is unremarkable. His dietary history reveals limited consumption of iron-rich foods, and food preferences of fast food.  

On physical examination, the child appears fatigued, pale. His vital signs were noted as a heart rate of 98 bpm, blood pressure of 95/60 mmHg, and a respiratory rate of 20 breaths per minute. His skin and conjunctiva were noticeably pale, he had a smooth tongue and a mild tenderness on abdominal palpation with no organomegaly. The patient is alert and oriented. Laboratory investigations reveal a hemoglobin level of 8.5 g/dL, hematocrit of 25%, a mean corpuscular volume of 70 fL, and a red blood cell count of 4.0 million cells/mc. His iron studies indicate low serum iron levels, ferritin and increased TIBC. Additional tests including a stool test for occult blood and reticulocyte count, were negative.