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CPE-011 · synthetic case ANEM-FX-03
Macrocytic anemia with low B12 and hypersegmented neutrophils
MCV 112.
Purpose: MCV 112.
Inputs the engine received
CBC and reticulocytes
- Hemoglobin
- 9.2 g/dL
- Hematocrit
- 28 %
- MCV
- 112 fL
- Reticulocytes
- 0.6 %
Patient
- Age
- 65 years
- Sex
- Male
Iron, vitamins and inflammation
- Vitamin B12
- 140 pg/mL
Blood film and other context
- Hypersegmented neutrophils
- Yes
What the engine reports
Detected clinical pattern
Macrocytic Anemia — Pattern Compatible With B12 or Folate Deficiency
Moderate anemia, macrocytic. A pattern for physician review; the cause still has to be found.
- Severity: Moderate anemia (Hb 9.2 g/dL)
- Morphology: Macrocytic (MCV >100)
- Marrow response: Marrow response inadequate (RPI 0.19)
Calculations
- Corrected reticulocyte count
- 0.37%
- Reticulocyte production index
- 0.19
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.
- 1Check B12 before folic acid; the Vitamin B12 and Folate Pattern Engine applies the safety rules.
Missing information
- Ferritin (and transferrin saturation).
Evidence and rule trace · 6 rules
AN-13Megaloblastic pattern
Inputs: MCV 112 fL · B12 140 pg/mL · hypersegmented neutrophils
Pattern compatible with vitamin B12 or folate 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-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.
- EV-DEVALIA-2014 · Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
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-01
Microcytic anemia with low ferritin
A 36-year-old, Hb 9.9, MCV 72, ferritin 6, TSAT 7%.
ANEM-FX-02
Microcytic anemia, normal iron indices and a low Mentzer index
MCV 62, RBC 5.7.
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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