1) iron deficiency (with or without blood loss),
2) chronic disease/inflammation
3) chronic kidney disease
4) deficiencies of folate or vitamin B-12,
5) diseases of the bone marrow
6) hypothyroidism, hypersplenism, and hemolytic anemia
So investigations entail;
1) Complete blood count (CBC)
2) Peripheral blood film
3) Vitamin B-12
5) Reticulocyte count
7) Thyroid-stimulating hormone
8) Serum creatinine and estimated glomerular filtration rate
9) Serum ferritin
10) Serum iron
11) Total iron-binding capacity.
These work up should be able to point to the diagnosis and accordingly treatment can instituted. Meanwhile Anxiety can be treated by the following measures by yourself;1) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT); done by a psychologist.
2) Relaxation training and biofeedback.
4) Acupuncture and acupressure
7) Group sporting activities
8) St. John's wort
9) Melatonin10) Valerian root
1) electromyography (EMG)
2) nerve conduction velocity (NCV)
3) blood electrolytes like calcium, magnesium, potassium, sodium, etc
4) thyroid and parathyroid function tests
5) blood chemistry and complete metabolic profile
The common causes can be;
1) Idiopathic; no cause is ascertained and majority falls in this group.
2) Increased caffeine intake
3) Increased alcohol intake
5) Deficiency in diet and nutrients / minerals
6) Some neurological diseases; uncommon
As we discussed; twitching usually is benign and do not point to any serious issue. Anxiety itself can be responsible for the muscle twitching.
I would be happy to assist you further, if you need any more information.