Ask your advice about a patient's iron deficiency anemia that was an incidental finding right so she is a 76 year old on the unit and we've been doing her blood bleeds now because of recent hyponatremia and her hemoglobin dropped from 1 26 to 1 13 in about 2 weeks could right could be that she sustained a pelvic fracture about a few weeks ago as well and she has we've done folate vitamin b 12 has been normal but her iron study the iron and the trans transferrin saturation is low how low are we talking or give me the number and I'll have a look at the bloods okay can I just hold on 1 like this is for me to open the system because I don't remember the thank you or you could give me the patient's hospital number I can oh yeah please okay so the nhs number is 454454 mhmm 901 mhmm 5594 thank you oh I've got someone dead 5 hello would you tell me again I've got someone who's dead 4540 okay 454 yeah 901901 5594 5594 I don't know what happened no I've got jenny atkinson who's unfortunately deceased no maybe can you hear me okay yeah I can okay go ahead so it's kathleen wooden so it's 454 yeah 901 mhmm 55 mhmm 94 and that's her nhs number yeah I don't know what's wrong with my computer ah got her brilliant got her okay sorry I don't know I think it was now I can it was doing the hospital number with what we were typing before and I just needed to be more patient so her ferritin's 314 that's quite reassuring and her transferrin saturation is 12% but low transferrin levels I don't think she is iron deficient look we for us if a ferritin is over a 150 then even within the context of inflammation we don't think they have absolute iron deficiency okay so I think this is most likely to be an anemia of chronic disease or okay something related to her hip fracture and I would give it time recheck it when she's better I doubt very much that this is iron deficiency her mcv is normal which goes against iron deficiency you can get decreased transferrin saturations in the context of the acute phase that okay body's trying to sequester iron and store it away so your transferrin sat weirdly goes down even though we think it's the best test it's probably not the best test is ferritin less than a 150 in the context of a microcytosis neither of which she has so I wouldn't worry about that in terms of ida so just continue monitoring it and no no need for any further investigation I wouldn't rush to investigate further yeah I think when yeah when this lovely lady's better maybe when she's home in a couple of months' time she could have them recheck with her gp to make sure her hemoglobin returns to normal and at that? We could recheck the ferritin and see but I wouldn't rush to do anything at the moment yeah yeah thank you so much pleasure nice to talk to you can I get your name of course my name is rob miller I'm 1 of the gastroenterologists rob miller rob thank you so much thanks bye bye bye bye