### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi I have a 5 year old daughter who has a very pale skin complexion anyway but she has dark under her eyes and she gets increasingly run down during different periods of the year, although these can be on an ad hoc basis (so not just through winter). Throughout the year last year she was feeling ill and run down on a frequent basis (but with no cold or any other similar symptoms), sufferes from aches and pains in her legs (from her knees to even her ankles) and her wrists, sleeps for 12 hours a night but is always telling me she feels tired and now she says her heart is hurting her (I assume it is beating fast and yesterday morning she had only walked from the dining room into the kitchen when she told me). Also on an ad hoc basis she has a red flaring of the skin around her vaginal area and the only thing that will ease it is a cold wet flannel (all creams burn) and this only occurs when she is is in bed and has been sleeping. She had bloods taken last year on my insistence because I had had enough of being given the run around (they check her vitals at the doctors and because they are okay on the day they say there is nothing wrong). Not the pleasantest of experience for her and not something I wanted to do but I had to do it for peace of mind. Anyway, they all came back negative (I was surprised because I though her iron may be low). In the end the attributed it to the fact that she doesn t go to the toilet properly and the toxins from her stools are feeding themselves back into her body but she has never been a regular toilet go er. Any ideas as to what could be wrong? Many thanks Zoe

### output:

These all ate symptoms of anemia, a condition of low hemoglobin or red blood cells on the blood.However, routine investigations may be normal at times. You should go for a detail peripheral blood film and also a serum folate level, serum vitamin B12 levels and seem ferritin levels.Also, the redness around vaginal area and that too only in bed is due to worm infestation. So you should deform her by giving Tab.zen tel. Meanwhile you should start iron with folic acid and vitamin B 12 in the form of a syrup. The symptoms should abate.