Anne cooper +1 008811 I had the pleasure of meeting missus cooper alongside her daughter in gastroenterology clinic doctor saunders full stop the consultation was face to face full stop <\n\n> On examination height hundred and 64 cm weight 56.75 kg bmi 21.1 <\n\n> Thank you very much for referring missus cooper with a new microcytosis full stop and note that she has been anemic for some time since at least 2021 and her daughter recalls that in 2020 they had difficulties with anemia along at the time of her hip operation she required an iron infusion in order to optimize her perioperatively full stop <\n\n> Despite this long standing anemia, her mean cell volume has been down trending over the last year and she's currently microcytic with a slightly high platelet level and a ferritin of 224 full stop this isn't conclusive of iron deficiency however the progressive microcytosis as well as the high fit test make us consider further investigations for her full stop <\n\n> She has no gastroenterological symptoms of note full stop her weight is stable full stop <\n\n> She started her doxepam 2 years ago for atrial fibrillation which is the same time as her mce started to decrease full stop <\n\n> Her main symptom is of breathlessness which stops her after about 20 steps full stop <\n\n> An element of this breathlessness may be due to her ida but the majority of it would be due to left ventricular failure and her recent bnp was over 4,000 full stop <\n\n> Despite her decreased exercise tolerance she lives independently in a cottage by herself full stop she drives to the supermarket full stop she drinks alcohol sparingly and is a nonsmoker full stop <\n\n> She's very independent full stop <\n\n> We discussed today that her blood tests are suggestive of iron deficiency even with this relatively high ferritin level full stop there's likely to be a element of anemia of chronic disease from her lv systolic dysfunction as part of this anemia however we discussed investigations which we might perform for iron deficiency anemia full stop <\n\n> Her risk of malignancy associated with anemia is 11.2% we discussed that a lot of that is driven by her age and the duration of her anemia is quite reassuring in itself full stop <\n\n> She's not noticed any bleeding from anywhere full stop <\n\n> We discussed today that the investigations of choice here would be an upper gi endoscopy with sedation as well as a ct abdomen and pelvis with 2 days of gastrografem prep and a lower gi study full stop she'd be happy to have these tests performed full stop I don't think she'd tolerate a colonoscopy and I don't think it would provide a huge amount of additional benefit over a ct scan full stop I think that if required she could need she could have a colonoscopy however her breathlessness on exertion and the fact that she lives alone makes me mildly reluctant give her bowel preparation full stop she knows that she'll need someone to look after her and take her back from the endoscopy if she has upper gi endoscopy if she has sedation full stop <\n\n> She's also gonna have some blood tests done to explain to see the abscess of course I look forward to writing on the results of her investigations you also see him