Physician's Assistant

Refined clinic letter Fri 02 January 2026 11:25

Last Modified: 94 days ago

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Diagnosis:
Iron deficiency anaemia - November 2025

Other Medical Diagnoses:
• Type 2 diabetes mellitus
• Atrial fibrillation - on anticoagulation
• Squamous cell carcinoma of the tongue 2016 - treated with operative management, chemotherapy and radiotherapy

Current Medications:
• Betamethasone cream topical PRN
• Bisoprolol
• Edoxaban
• Levothyroxine
• Ferrous sulfate 200mg PO OD for 3 months - STARTED TODAY

Investigations:
• qFIT November 2025: 90
• FBC November 2025: Hb 105, MCV 66.8 
• FBC 2024: Hb 147, MCV 8
• Clinic blood tests: Ferritin 9, Tsat 4%, B12 and Folate normal, Hb 117, TTG awaited

Management Plan:
1. Bidirectional endoscopy (requested)
2. Iron supplementation for 3 months (prescription given)
3. Blood tests today including haematinics and coeliac screen (results above)
4. Write with results

I had the pleasure of meeting Mr Palk in iron deficiency anaemia clinic today on behalf of Dr Powles.

He has developed iron deficiency anaemia over the last year with evidence of microcytosis on his recent blood tests in November 2025. His blood tests in 2024 were normal, showing no evidence of iron deficiency at that time. Over recent months he has been feeling increasingly fatigued and tired, and had a single episode of jet black tarry stool one month ago.

Of note, he has been on edoxaban for atrial fibrillation since April 2023. He has been struggling with his dentition following treatment for tongue cancer in 2016, and has been seeing the restorative dentistry team for the last 12 months trying to improve his ability to eat. He is currently on an entirely soft pasta diet but does include tuna with his pasta and lasagnas, so his dietary iron intake should be sufficient. His weight is stable.

He continues to work four days a week with his flooring business and lives with his wife. His performance status is 0.

We discussed that his blood tests demonstrate iron deficiency anaemia and his stool test shows microscopic blood. Combined with his episode of melaena, this raises concern about gastrointestinal bleeding which can be from benign as well as malignant causes. Overall his risk of malignancy is around 10%. He is fit for bidirectional endoscopy and is happy to proceed with these investigations. I have started him on a 3-month course of iron supplementation and arranged blood tests today including haematinics and coeliac screening. He knows will need to stop his edoxaban 3 days prior to the endoscopy procedures.

I look forward to seeing the results of his endoscopies and will write with them.

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Refined clinic letter Fri 02 January 2026 11:25

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