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CPE-011 · synthetic case ANEM-FX-04

Hemolysis: reticulocytes 12%, LDH 640, haptoglobin 5

Spherocytes and a positive DAT.

Synthetic · no real patientAuthored by Biod · reviewed by Dr. AmaralAnemia engine v1.0.0

Purpose: Spherocytes and a positive DAT.

Inputs the engine received

CBC and reticulocytes

Hemoglobin
7.6 g/dL
Hematocrit
23 %
MCV
98 fL
Reticulocytes
12 %

Patient

Age
41 years
Sex
Female

Hemolysis, kidney and thyroid

LDH
640 U/L
Haptoglobin
5 mg/dL
Indirect bilirubin
3.2 mg/dL
Direct antiglobulin test positive
Yes

Blood film and other context

Spherocytes
Yes

What the engine reports

Detected clinical pattern

Anemia — Pattern Compatible With Hemolysis

Severe anemia, normocytic. A pattern for physician review; the cause still has to be found.

  • Severity: Severe anemia (Hb 7.6 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response appropriate (RPI 2.45)

Calculations

Corrected reticulocyte count
6.13%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
2.45

Corrected count ÷ maturation factor. 2 or more is an appropriate marrow response.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Direct antiglobulin test, blood film and a search for the cause (autoimmune, mechanical, hereditary, drug, infection).

Missing information

  • Ferritin (and transferrin saturation).
Evidence and rule trace · 6 rules

AN-CALC-01Derived values

Inputs: RPI 2.45

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 7.6 g/dL (<12)

Anemia, severe.

AN-02Morphology by MCV

Inputs: MCV 98 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 12% · hematocrit 23% · RPI 2.45

Appropriate marrow response.

AN-14Hemolysis pattern

Inputs: RPI/retic 2.45 · LDH 640 U/L · haptoglobin 5 mg/dL · indirect bilirubin 3.2 mg/dL · spherocytes · direct antiglobulin test positive

Pattern compatible with hemolysis.

AN-MISS-01Information needed

Inputs: Ferritin

First-line studies are incomplete.

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-JAGER-2020 · Jäger U, Barcellini W, Broome CM, et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting. Blood Rev. 2020;41:100648.

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.

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Morphology

  1. ✓ Microcytic

    MCV <80 fL

  2. ● Normocytic

    MCV 80–100 fL

  3. ○ Macrocytic

    MCV >100 fL

Marrow response (reticulocyte production index)

  1. ✓ Inadequate · RPI <2

    Hypoproliferative: deficiency, inflammation, kidney, marrow

  2. ● Appropriate · RPI ≥2

    Blood loss, hemolysis or recovery

CBC and reticulocytes
  • <7
  • 7–8
  • 8–11
  • 11–13
  • ≥13
Patient
Sex
Iron, vitamins and inflammation
Hemolysis, kidney and thyroid

250 U/L is assumed when empty.

Blood film and other context

Live result · computed in your browser

Detected clinical pattern

Anemia — Pattern Compatible With Hemolysis

Severe anemia, normocytic. A pattern for physician review; the cause still has to be found.

  • Severity: Severe anemia (Hb 7.6 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response appropriate (RPI 2.45)

Calculations

Corrected reticulocyte count
6.13%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
2.45

Corrected count ÷ maturation factor. 2 or more is an appropriate marrow response.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Direct antiglobulin test, blood film and a search for the cause (autoimmune, mechanical, hereditary, drug, infection).

Missing information

  • Ferritin (and transferrin saturation).
Evidence and rule trace · 6 rules

AN-CALC-01Derived values

Inputs: RPI 2.45

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 7.6 g/dL (<12)

Anemia, severe.

AN-02Morphology by MCV

Inputs: MCV 98 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 12% · hematocrit 23% · RPI 2.45

Appropriate marrow response.

AN-14Hemolysis pattern

Inputs: RPI/retic 2.45 · LDH 640 U/L · haptoglobin 5 mg/dL · indirect bilirubin 3.2 mg/dL · spherocytes · direct antiglobulin test positive

Pattern compatible with hemolysis.

AN-MISS-01Information needed

Inputs: Ferritin

First-line studies are incomplete.

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-JAGER-2020 · Jäger U, Barcellini W, Broome CM, et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting. Blood Rev. 2020;41:100648.

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.

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-03

Macrocytic anemia with low B12 and hypersegmented neutrophils

MCV 112.

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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