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CPE-011 · synthetic case ANEM-FX-13
Blasts on the film
WBC 41.
Purpose: WBC 41.
Inputs the engine received
CBC and reticulocytes
- Hemoglobin
- 9 g/dL
- WBC
- 41 ×10³/µL
- Platelets
- 80 ×10³/µL
Patient
- Age
- 55 years
- Sex
- Female
Blood film and other context
- Blasts
- Yes
What the engine reports
Urgent hematology evaluation for possible acute leukemia is needed.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Severity: Moderate anemia (Hb 9 g/dL)
- Pattern: unclassified anemia unclassified
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent hematology evaluation.
Missing information
- Reticulocyte percentage with hematocrit (marrow response).
- Ferritin (and transferrin saturation).
- MCV (morphology).
Evidence and rule trace · 3 rules
AN-SAFE-05Blasts or marked leukocytosis
Inputs: blasts on the film
Urgent hematology evaluation: possible acute leukemia.
AN-MISS-01Information needed
Inputs: Reticulocyte percentage with hematocrit · 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.
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
No stage is assigned for the values entered.
Marrow response (reticulocyte production index)
○ Inadequate · RPI <2
Hypoproliferative: deficiency, inflammation, kidney, marrow
○ 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
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-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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