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CPE-011 · synthetic case ANEM-FX-08

Schistocytes with platelets 40

A thrombotic microangiopathy pattern.

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

Purpose: A thrombotic microangiopathy pattern.

Inputs the engine received

CBC and reticulocytes

Hemoglobin
7.9 g/dL
Hematocrit
24 %
Reticulocytes
6 %
Platelets
40 ×10³/µL

Patient

Age
37 years
Sex
Female

Hemolysis, kidney and thyroid

LDH
900 U/L

Blood film and other context

Schistocytes
Yes

What the engine reports

Priority

Anemia with severe thrombocytopenia

AN-17

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

Detected clinical pattern

Urgent Review Finding

A safety rule calls for urgent clinical assessment. Read the safety findings first.

  • Severity: Severe anemia (Hb 7.9 g/dL)
  • Marrow response: Marrow response inadequate (RPI 1.28)
  • Pattern: marrow failure pattern

Calculations

Corrected reticulocyte count
3.2%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
1.28

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Urgent hematology evaluation for thrombotic microangiopathy.
  2. 2Hematology evaluation of the cytopenias.
  3. 3Direct antiglobulin test, blood film and a search for the cause (autoimmune, mechanical, hereditary, drug, infection).

Missing information

  • Ferritin (and transferrin saturation).
  • MCV (morphology).
Evidence and rule trace · 7 rules

AN-CALC-01Derived values

Inputs: RPI 1.28

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 7.9 g/dL (<12)

Anemia, severe.

AN-03Marrow response

Inputs: retic 6% · hematocrit 24% · RPI 1.28

Inadequate marrow response.

AN-14Hemolysis pattern

Inputs: RPI/retic 1.28 · LDH 900 U/L · schistocytes

Pattern compatible with hemolysis.

AN-17Cytopenias: marrow involvement possible

Inputs: anemia with platelets 40

Pattern that raises marrow failure or infiltration.

AN-SAFE-03Thrombotic microangiopathy pattern

Inputs: schistocytes on the film · platelets 40

Urgent: thrombotic microangiopathy pattern.

AN-MISS-01Information needed

Inputs: Ferritin · MCV

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-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.
  • 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.
  • EV-ISTH-TTP-2020 · Zheng XL, Vesely SK, Cataland SR, et al. ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura. J Thromb Haemost. 2020;18(10):2486-2495.

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

No stage is assigned for the values entered.

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

Priority

Anemia with severe thrombocytopenia

AN-17

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

Detected clinical pattern

Urgent Review Finding

A safety rule calls for urgent clinical assessment. Read the safety findings first.

  • Severity: Severe anemia (Hb 7.9 g/dL)
  • Marrow response: Marrow response inadequate (RPI 1.28)
  • Pattern: marrow failure pattern

Calculations

Corrected reticulocyte count
3.2%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
1.28

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Urgent hematology evaluation for thrombotic microangiopathy.
  2. 2Hematology evaluation of the cytopenias.
  3. 3Direct antiglobulin test, blood film and a search for the cause (autoimmune, mechanical, hereditary, drug, infection).

Missing information

  • Ferritin (and transferrin saturation).
  • MCV (morphology).
Evidence and rule trace · 7 rules

AN-CALC-01Derived values

Inputs: RPI 1.28

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 7.9 g/dL (<12)

Anemia, severe.

AN-03Marrow response

Inputs: retic 6% · hematocrit 24% · RPI 1.28

Inadequate marrow response.

AN-14Hemolysis pattern

Inputs: RPI/retic 1.28 · LDH 900 U/L · schistocytes

Pattern compatible with hemolysis.

AN-17Cytopenias: marrow involvement possible

Inputs: anemia with platelets 40

Pattern that raises marrow failure or infiltration.

AN-SAFE-03Thrombotic microangiopathy pattern

Inputs: schistocytes on the film · platelets 40

Urgent: thrombotic microangiopathy pattern.

AN-MISS-01Information needed

Inputs: Ferritin · MCV

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-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.
  • 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.
  • EV-ISTH-TTP-2020 · Zheng XL, Vesely SK, Cataland SR, et al. ISTH guidelines for the diagnosis of thrombotic thrombocytopenic purpura. J Thromb Haemost. 2020;18(10):2486-2495.

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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