Age: 66.0
Sex: M
Vaccine: COVID19
Symptoms: Colonoscopy normal, Dyspnoea, Endoscopy upper gastrointestinal tract normal, Haemoglobin decreased, Hypotension
Clinical narrative: Pfizer Dose 1 2/12/21 (EN5318) Pfizer Dose 2 3/11/21 (EL9266) COVID Positive 2/14/22  2/14/22: Patient is a 67-year-old male with history of HTN, HLD, NIDDM, CKD(IV), and chronic blood loss anemia. Patient has had recurrent GI bleeding with negative upper GI endoscopy and colonoscopy as recently as 9/1/2021.  He follows with hematology for chronic iron deficiency anemia and leukopenia.  He presented to the emergency department today with complaints of chest pain and shortness of breath.  He was found to have a hemoglobin of 7.9.  Also had FOBT positive.  GI was consulted from ED and recommended treating him with 1 unit of PRBCs and discharging him home to complete his OP workup.  The patient was noted to have several antibodies on his type and screen, and blood will likely not be ready tonight. Patient will be admitted for observation, receive his blood transfusion, and likely discharge home in a.m..   ED reported the patient was 79% on room air on arrival to the ED.  They placed him on 2L of supplemental oxygen.  On my exam, the patient dropped no lower than 92% on room air, this even with holding a conversation.  He denies any shortness of breath or chest pain currently.  Reports that the symptoms that brought him into the ED have completely resolved.  His vitals have been stable in the ED.  His CXR showed no acute cardiopulmonary processes.  Creatinine is elevated at 2.47, but the patient does have a history of CKD(IV) and is at baseline.  On recent Hematology notes, patient is noted to be quite iron deficient, but does not tolerate oral iron therapy due to significant constipation. He receives IV iron supplementation at times.  Will give him Venofer while admitted.  2/17/22: Patient is a 67-year-old male with history of HTN, HLD, NIDDM, CKD(IV), and chronic blood loss anemia with recurrent GI bleeding.  Has had negative upper GI endoscopy and colonoscopy as recently as 9/1/2021.  He follows with hematology for chronic iron deficiency anemia and leukopenia.  Patient was admitted on 2/14/2022 with acute on chronic blood loss anemia and positive fecal occult blood test.  GI was consulted from the ED, and they recommended transfusing the patient with 1 unit PRBCs and discharging him home to complete his outpatient follow-up. Unfortunately, the patient had several antibodies on his screening, and had to be admitted for blood transfusion. As the patient was being admitted, he was screened for COVID-19.  His screening test came back positive.  The patient's chest x-ray showed no pneumonia.  He was admitted, received 1 unit PRBC, then demonstrated some mild hypotension.  This resolved with fluid resuscitation.  The patient today reports that he is feeling well.  He denies shortness of breath at rest, dyspnea on exertion, chest pain, palpitations.  He did have a home oxygen walk which showed that he needs 1L of oxygen with activity, but requires no oxygen at rest.  Physical therapy evaluated the patient and felt that he would benefit from VNA.  He will be discharged home today with VNA for nursing and physical therapy.