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CPE-011 · synthetic case ANEM-FX-07

Pancytopenia

Hb 8.5, WBC 2.4, platelets 62.

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

Purpose: Hb 8.5, WBC 2.4, platelets 62.

Inputs the engine received

CBC and reticulocytes

Hemoglobin
8.5 g/dL
MCV
104 fL
WBC
2.4 ×10³/µL
Platelets
62 ×10³/µL

Patient

Age
72 years
Sex
Male

What the engine reports

Priority

Pancytopenia

AN-17

This pattern raises marrow failure, infiltration or severe megaloblastic anemia, and needs hematology evaluation.

Detected clinical pattern

Cytopenias Raising Marrow Involvement

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

  • Severity: Moderate anemia (Hb 8.5 g/dL)
  • Morphology: Macrocytic (MCV >100)

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Hematology evaluation of the cytopenias.

Differentials, pitfalls and contradicting signals

  • Non-vitamin causes of macrocytosis present: age ≥60 with cytopenias. They can coexist with a vitamin deficiency.

Missing information

  • Reticulocyte percentage with hematocrit (marrow response).
  • Ferritin (and transferrin saturation).
  • Vitamin B12 and folate (macrocytic anemia).
Evidence and rule trace · 5 rules

AN-01Anemia present, with severity

Inputs: hemoglobin 8.5 g/dL (<13)

Anemia, moderate.

AN-02Morphology by MCV

Inputs: MCV 104 fL

Macrocytic anemia.

AN-17Cytopenias: marrow involvement possible

Inputs: Hb 8.5, WBC 2.4, platelets 62

Pattern that raises marrow failure or infiltration.

AN-18Macrocytosis from non-vitamin causes

Inputs: age ≥60 with cytopenias

Non-vitamin causes of macrocytosis are present.

AN-MISS-01Information needed

Inputs: Reticulocyte percentage with hematocrit · Ferritin · Vitamin B12 and folate

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-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

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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

No stage is assigned for the values entered.

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

Priority

Pancytopenia

AN-17

This pattern raises marrow failure, infiltration or severe megaloblastic anemia, and needs hematology evaluation.

Detected clinical pattern

Cytopenias Raising Marrow Involvement

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

  • Severity: Moderate anemia (Hb 8.5 g/dL)
  • Morphology: Macrocytic (MCV >100)

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Hematology evaluation of the cytopenias.

Differentials, pitfalls and contradicting signals

  • Non-vitamin causes of macrocytosis present: age ≥60 with cytopenias. They can coexist with a vitamin deficiency.

Missing information

  • Reticulocyte percentage with hematocrit (marrow response).
  • Ferritin (and transferrin saturation).
  • Vitamin B12 and folate (macrocytic anemia).
Evidence and rule trace · 5 rules

AN-01Anemia present, with severity

Inputs: hemoglobin 8.5 g/dL (<13)

Anemia, moderate.

AN-02Morphology by MCV

Inputs: MCV 104 fL

Macrocytic anemia.

AN-17Cytopenias: marrow involvement possible

Inputs: Hb 8.5, WBC 2.4, platelets 62

Pattern that raises marrow failure or infiltration.

AN-18Macrocytosis from non-vitamin causes

Inputs: age ≥60 with cytopenias

Non-vitamin causes of macrocytosis are present.

AN-MISS-01Information needed

Inputs: Reticulocyte percentage with hematocrit · Ferritin · Vitamin B12 and folate

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-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.

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-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%.

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