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CPE-011 · synthetic case ANEM-FX-14

High RDW with a normal MCV

Two processes possible.

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

Purpose: Two processes possible.

Inputs the engine received

CBC and reticulocytes

Hemoglobin
10.8 g/dL
Hematocrit
33 %
MCV
88 fL
RDW
18.2 %
Reticulocytes
1 %

Patient

Age
44 years
Sex
Female

Iron, vitamins and inflammation

Ferritin
20 ng/mL
Transferrin saturation
11 %

What the engine reports

Detected clinical pattern

Anemia — Pattern Compatible With Iron Deficiency

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

  • Severity: Moderate anemia (Hb 10.8 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response inadequate (RPI 0.37)

Calculations

Corrected reticulocyte count
0.73%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
0.37

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Establish the source of iron loss or poor absorption; the Iron Deficiency Pattern Engine applies the gastrointestinal-evaluation rules.

Differentials, pitfalls and contradicting signals

  • A high RDW with a normal MCV suggests two processes with opposite effects on cell size, for example iron deficiency with B12 or folate deficiency.
Evidence and rule trace · 6 rules

AN-CALC-01Derived values

Inputs: RPI 0.37

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 10.8 g/dL (<12)

Anemia, moderate.

AN-02Morphology by MCV

Inputs: MCV 88 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 1% · hematocrit 33% · RPI 0.37

Inadequate marrow response.

AN-04Mixed anemia suspected

Inputs: RDW 18.2% · MCV 88 fL

High RDW with normal MCV: two processes possible.

AN-10Iron-deficiency pattern

Inputs: ferritin 20 ng/mL · TSAT 11%

Pattern compatible with iron 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-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.

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 Iron Deficiency

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

  • Severity: Moderate anemia (Hb 10.8 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response inadequate (RPI 0.37)

Calculations

Corrected reticulocyte count
0.73%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
0.37

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Establish the source of iron loss or poor absorption; the Iron Deficiency Pattern Engine applies the gastrointestinal-evaluation rules.

Differentials, pitfalls and contradicting signals

  • A high RDW with a normal MCV suggests two processes with opposite effects on cell size, for example iron deficiency with B12 or folate deficiency.
Evidence and rule trace · 6 rules

AN-CALC-01Derived values

Inputs: RPI 0.37

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 10.8 g/dL (<12)

Anemia, moderate.

AN-02Morphology by MCV

Inputs: MCV 88 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 1% · hematocrit 33% · RPI 0.37

Inadequate marrow response.

AN-04Mixed anemia suspected

Inputs: RDW 18.2% · MCV 88 fL

High RDW with normal MCV: two processes possible.

AN-10Iron-deficiency pattern

Inputs: ferritin 20 ng/mL · TSAT 11%

Pattern compatible with iron 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-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-MENTZER-1973 · Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.

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%.

All anemia cases

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