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CPE-011 · synthetic case ANEM-FX-01
Microcytic anemia with low ferritin
A 36-year-old, Hb 9.9, MCV 72, ferritin 6, TSAT 7%.
Purpose: A 36-year-old, Hb 9.9, MCV 72, ferritin 6, TSAT 7%.
Inputs the engine received
CBC and reticulocytes
- Hemoglobin
- 9.9 g/dL
- Hematocrit
- 31 %
- MCV
- 72 fL
- RDW
- 17 %
- RBC count
- 4.6 ×10¹²/L
- Reticulocytes
- 0.8 %
Patient
- Age
- 36 years
- Sex
- Female
Iron, vitamins and inflammation
- Ferritin
- 6 ng/mL
- Transferrin saturation
- 7 %
What the engine reports
Detected clinical pattern
Anemia — Pattern Compatible With Iron Deficiency
Moderate anemia, microcytic. A pattern for physician review; the cause still has to be found.
- Severity: Moderate anemia (Hb 9.9 g/dL)
- Morphology: Microcytic (MCV <80)
- Marrow response: Marrow response inadequate (RPI 0.28)
Calculations
- Mentzer index
- 15.7
- Corrected reticulocyte count
- 0.55%
- Reticulocyte production index
- 0.28
MCV ÷ RBC count. Below 13 favors thalassemia trait; a screen only.
Reticulocyte % × (hematocrit ÷ 45).
Corrected count ÷ maturation factor. 2 or more is an appropriate marrow response.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Establish the source of iron loss or poor absorption; the Iron Deficiency Pattern Engine applies the gastrointestinal-evaluation rules.
Evidence and rule trace · 5 rules
AN-10Iron-deficiency pattern
Inputs: ferritin 6 ng/mL · TSAT 7% · microcytic
Pattern compatible with iron deficiency.
Evidence
- EV-WHO-HB-2011 · World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
- EV-TEFFERI-2003 · Tefferi A. Anemia in adults: a contemporary approach to diagnosis. Mayo Clin Proc. 2003;78(10):1274-1280.
- EV-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
- EV-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.
Physician adjudication required. Clinical decision support for physician review. This output classifies anemia by morphology and marrow response and lists patterns and safety considerations. It does not diagnose a cause, rank causes by probability, or select treatment or transfusion. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Morphology
● Microcytic
MCV <80 fL
○ Normocytic
MCV 80–100 fL
○ Macrocytic
MCV >100 fL
Marrow response (reticulocyte production index)
● Inadequate · RPI <2
Hypoproliferative: deficiency, inflammation, kidney, marrow
○ Appropriate · RPI ≥2
Blood loss, hemolysis or recovery
CBC and reticulocytes
- <7
- 7–8
- 8–11
- 11–13
- ≥13
Patient
Iron, vitamins and inflammation
Hemolysis, kidney and thyroid
250 U/L is assumed when empty.
Blood film and other context
More anemia cases
ANEM-FX-02
Microcytic anemia, normal iron indices and a low Mentzer index
MCV 62, RBC 5.7.
ANEM-FX-03
Macrocytic anemia with low B12 and hypersegmented neutrophils
MCV 112.
ANEM-FX-04
Hemolysis: reticulocytes 12%, LDH 640, haptoglobin 5
Spherocytes and a positive DAT.
ANEM-FX-05
Anemia in CKD
eGFR 28, normocytic, low reticulocytes, iron replete.
ANEM-FX-06
Anemia of inflammation
CRP 30, ferritin 340, TSAT 12%.
ANEM-FX-07
Pancytopenia
Hb 8.5, WBC 2.4, platelets 62.
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