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Patient Details

Refined clinic letter (94 days ago 11:57)

Refined clinic letter Fri 02 January 2026 11:57

Last Modified: 94 days ago

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Content:

Diagnosis:
Iron deficiency anaemia - December 2025

Other Medical Diagnoses:
• ST elevation myocardial infarction - December 2025 (treated with primary PCI)
• Asthma
• Hypertension
• Hyperlipidaemia

Current Medications:
• Aspirin
• Clopidogrel
• Cetirizine
• Montelukast
• Simcor
• Fluvastatin
• Ramipril
• Lansoprazole
• Bisoprolol
• Ventolin
• Terbinafine
• Omeprazole
• Metolazone
• GTN spray
• Nicorette inhalator
• Nicorette patch

On examination: Height 159cm, Weight 77kg, BMI 30.5

Investigations:
• OGD (December 2025): Mild patchy erythema in stomach, no significant abnormality. D2 biopsies taken - results awaited
• FBC (30/12/2025): Hb 110 (previous nadir 90 g/L during admission), with microcytosis
• Haematinics (December 2025): Ferritin 23, Folate normal, B12 normal, Transferrin saturation 2%, Transferrin level 3.1
• TTG (December 2025): Negative
• CT Abdomen and Pelvis (December 2025): Normal intra-abdominal appearances, infective right lung base changes
• Historical bloods: Hb trend showing decline from 145 (2020) to current levels, with developing microcytosis since 2022

Management Plan:
1. CT colonoscopy (requested)
2. Continue iron infusions (second infusion due Tuesday)
3. If target for therapy on CT Colonoscopy, for discussion with cardiology on optimal timings.
4. Write with results

I had the pleasure of meeting Mrs Stanton in gastroenterology clinic on behalf of Dr Powels.

Mrs Stanton has had a challenging few months, having suffered an ST elevation myocardial infarction in December 2025 requiring primary PCI. During her admission, she was found to be anaemic with iron deficiency. An OGD showed only mild patchy antral erythema. CT abdomen and pelvis showed no concerning lower GI lesions, though this was performed without preparation or air insufflation.

Reviewing her historical blood results, there has been a clear trend of declining haemoglobin from 145 g/L in 2020 to her recent nadir of 90 g/L, with developing microcytosis since 2022. Her current haemoglobin has improved to 110 g/L following iron infusion, with a second infusion planned.

She denies any GI symptoms and her weight has been stable, having gained approximately 1.5 stones over the past 2 years. She works in a nursery caring for children and has a 30 pack-year smoking history but has recently stopped, though is struggling particularly around relatives who smoke. She would benefit from additional smoking cessation support.

We discussed that her iron deficiency anaemia suggests possible slow GI blood loss. While her upper endoscopy was reassuring, her CT scan cannot confidently exclude colonic pathology. Potential causes include benign vascular malformations, polyps, or early malignancy.

Given her recent cardiac stenting and requirement for dual antiplatelet therapy for the next year, I am reluctant to arrange colonoscopy which would require stopping ticagrelor for 7 days. I therefore plan to arrange CT colonoscopy initially, which would not require cessation of antiplatelet therapy. If polyps are detected, we can then discuss optimal timing for therapeutic colonoscopy with the cardiology team.

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Refined clinic letter Fri 02 January 2026 11:57

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