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CPE-011 · synthetic case ANEM-FX-15
Macrocytosis with alcohol use disorder
No vitamin deficiency on the labs.
Purpose: No vitamin deficiency on the labs.
Inputs the engine received
CBC and reticulocytes
- Hemoglobin
- 11.2 g/dL
- Hematocrit
- 35 %
- MCV
- 106 fL
- Reticulocytes
- 1.5 %
Patient
- Age
- 50 years
- Sex
- Male
Iron, vitamins and inflammation
- Vitamin B12
- 520 pg/mL
- Folate
- 9 ng/mL
Blood film and other context
- Alcohol use disorder
- Yes
- Liver disease
- Yes
What the engine reports
Detected clinical pattern
Macrocytic Anemia — No Etiologic Pattern Fires
Anemia is present and classified by morphology, but no etiologic pattern fires with the values entered. See the missing data.
- Severity: Mild anemia (Hb 11.2 g/dL)
- Morphology: Macrocytic (MCV >100)
- Marrow response: Marrow response inadequate (RPI 0.78)
Calculations
- Corrected reticulocyte count
- 1.17%
- Reticulocyte production index
- 0.78
Reticulocyte % × (hematocrit ÷ 45).
Corrected count ÷ maturation factor. 2 or more is an appropriate marrow response.
Differentials, pitfalls and contradicting signals
- Non-vitamin causes of macrocytosis present: alcohol use disorder; liver disease. They can coexist with a vitamin deficiency.
Missing information
- Ferritin (and transferrin saturation).
Evidence and rule trace · 6 rules
AN-18Macrocytosis from non-vitamin causes
Inputs: alcohol use disorder · liver disease
Non-vitamin causes of macrocytosis are present.
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.
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
Marrow response (reticulocyte production index)
● Inadequate · RPI <2
Hypoproliferative: deficiency, inflammation, kidney, marrow
○ Appropriate · RPI ≥2
Blood loss, hemolysis or recovery
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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