Physician's Assistant

Refined clinic letter Fri 02 January 2026 12:43

Last Modified: 94 days ago

MRN:

Content:

Diagnosis:
Iron deficiency anaemia

Other Medical Diagnoses:
• Multilevel osteoporotic vertebral fractures - November 2024
• Congestive cardiac failure
• Obsessive compulsive disorder
• Urinary incontinence
• Previous peptic ulcer disease - 1970s

Current Medications:
• Tegretol
• Baclofen
• Mirabegron
• Fexofenadine

Investigations:
• FBC (17/12/2025): Hb 30, MCV 49.6, Platelets 470
• TTG (December 2025): Negative
• CT Thorax, Abdomen and Pelvis (December 2025): No evidence of metastatic malignancy, evidence of congestive cardiac failure, multilevel presumed osteoporotic vertebral fractures
• Clinic bloods Jan 26: B12 and folate normal, Hb 104

Management Plan:
1. Bidirectional endoscopy (upper GI endoscopy and colonoscopy) - as planned 
2. Write with results
3. Feraccru if Hb dropping following iron infusion

I had the pleasure of meeting Mrs Forbes in gastroenterology clinic today. The consultation was face-to-face and she was accompanied by Laura, her carer.

I'm sorry to hear that she was admitted to hospital acutely after routine blood tests with her GP because of fatigue demonstrated a haemoglobin of 30. She was feeling exhausted at this time but hadn't noticed any bleeding or weight loss. She underwent blood transfusion as well as iron infusion during her stay in hospital and is feeling a little better. She's previously been intolerant of iron supplementation due to constipation and so she's been having iron infusions.

She lives in a residential home, mobilises round her room with a frame and outside with a wheelchair. Approximately a year ago she experienced acute back pain when she was living in her park home and wasn't able to stand.

We spoke about her diet which sounds like it's good with good sources of dietary iron. She walks with a walking frame slowly around her room and uses a wheelchair outside of it.

She's already been planned for bidirectional endoscopy and we discussed her ability to tolerate the prep today, which it sounds like she's going to be able to manage, and I look forward to seeing the results of that. She's also going to have some blood tests today in order to ascertain whether she might benefit from any further iron supplementation.

I will write with the results of her tests.

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Summary:

Investigations:

Refined clinic letter Fri 02 January 2026 12:43

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