Physician's Assistant

Patient Details

Refined clinic supervision (15 weeks ago 14:56)

Refined clinic supervision Mon 22 December 2025 14:56

Last Modified: 15 weeks ago

MRN:

Content:

Jojo Gilley, 69, 645248.
New referral.
Main issue was new microcytic anaemia and positive FIT test.

This 69-year-old lady was referred with new microcytic anaemia developing since November 2024. Her Hb has dropped from 127 g/L in early October to 118 g/L currently, with MCV falling from 84.9 fL to 78.8 fL. FIT test is positive at 13 micrograms per gram. Iron studies show transferrin saturation 7% and ferritin 39 micrograms per litre, consistent with iron deficiency.

She reports fatigue and weakness over recent months, with some weight loss (clothes looser but not quantifiable). Three to four weeks ago she noticed episodes of dark red blood on stool and toilet paper, which has since resolved. She has regular bowel habit with Type 4 stools once daily, supported by Laxido. No abdominal pain or straining.

She lives in residential care and uses a wheelchair for mobility due to cervical spinal stenosis. She has a 47-pack-year smoking history (quit 10-12 years ago) and is vegetarian. Currently taking ferrous sulphate started 11/11/2024. Multiple comorbidities including T2DM, COPD, osteoarthritis, and psychiatric conditions. On prednisolone 15mg daily and aspirin which may contribute to GI blood loss.

Given her frailty and wheelchair use, we discussed that colonoscopy would be challenging due to bowel prep requirements and positioning difficulties. Upper GI endoscopy also problematic given transfer issues and low yield expected. We agreed on CT chest, abdomen and pelvis with oral contrast if today's blood tests confirm iron deficiency pattern (improved Hb with iron supplementation). If blood counts haven't improved, this would suggest anaemia of chronic disease rather than iron deficiency.

O/E: Unable to obtain height/weight due to wheelchair use. Patient appeared comfortable but tired.

Plan was blood tests today, then CT CAP if iron deficiency confirmed.

Point to discuss in supervision: Management approach for frail elderly patients with positive FIT where invasive endoscopy may carry disproportionate risk.

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Refined clinic supervision (104 days ago 06:28)

Refined clinic supervision Tue 23 December 2025 06:28

Last Modified: 104 days ago

MRN:

Content:

Jo Jo Gilley, 69F, 645248.
69-year-old lady with new iron deficiency anaemia pattern - Hb dropped from 127 (October) to 118, MCV from 84.9 to 78.8
Iron studies: transferrin saturation 7%, ferritin 39 mcg/L
IDIOM  2.8% risk , slightly increased with positive FIT

• FIT positive at 13 micrograms/g (normal <10)
• Reports fatigue and weakness over recent months
• 3-4 weeks ago noticed dark red blood on stool and paper for a few episodes, no further bleeding since
• Unquantifiable weight loss - clothes looser but not weighing regularly
• Regular bowel habit, type 4 stool once daily on Laxido
• Lives in residential care, wheelchair bound due to cervical spinal stenosis
• 90 pack-year smoking history, currently vaping, no alcohol
• Complex medical history including T2DM, COPD, schizoaffective disorder
• On a huge number of medications including prednisolone, aspirin, codeine
• Started on ferrous sulphate 22/11/2025 by GP
• Unable to examine due to wheelchair

Plan was:
• Blood tests today to assess response to iron supplementation
• If blood counts improved with iron: CT chest/abdomen/pelvis with 2 day prep
• If no improvement: likely anaemia of chronic disease

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