Physician's Assistant

MRN:

Content:

Diagnosis:
Iron deficiency anaemia - December 2025

Other Medical Diagnoses:
• Multilevel osteoporotic vertebral fractures - November 2024
• Congestive cardiac failure
• OCD
• Peptic ulcer disease - previous bleeding ulcer in twenties
• Urinary incontinence with frequency

Current Medications:
• Mirabegron
• Fexofenadine
• Tegretol
• Baclofen
• PPI (long-term)

Investigations:
• Haemoglobin 17/12/2025: 30 g/L (low), improved to 47, 72, then 74 g/L on 20/12/2025
• MCV: 49.6
• Platelets: 470
• TTG: Negative
• CT Thorax, Abdomen and Pelvis December 2025: No evidence of metastatic malignancy, congestive cardiac failure, multilevel presumed osteoporotic vertebral fractures

Management Plan:
1. Bidirectional endoscopy (upper GI and colonoscopy) scheduled for 10th January 2026 at 3:30pm
2. Blood tests today to check current haemoglobin and iron studies
3. Consider further iron infusion based on blood test results
4. Ferric carboxymaltose may be suitable given oral iron intolerance
5. Copy letter to endoscopy bookings team to clarify date and bowel preparation
6. Results letter following endoscopy procedures

I had the pleasure of meeting Mrs Forbes on behalf of Dr Poles 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 some routine blood tests with her GP because fatigue demonstrated a haemoglobin of 30 g/L, which was subsequently rechecked and found to be 29 g/L. She was feeling exhausted at this time but hadn't noticed any bleeding or weight loss. She underwent blood transfusion (12 units) 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 tells me they tested her urine in hospital and it was normal.

She's living in a care home at the moment because approximately a year ago she experienced acute back pain when she was living in her park home and wasn't able to stand. She subsequently came into hospital and was found to have had chronic spinal fractures and so she was rehabilitated and then now lives in a care home.

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 and she could be a good candidate for ferric carboxymaltose given her previous intolerance of other oral iron preparations.

I look forward to seeing the results of her tests.

Summary:

Investigations:

Patient Details

Refined clinic letter Fri 02 January 2026 12:34

Field Clipboard (for EPR paste)

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Refined clinic letter Fri 02 January 2026 12:43

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