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CPE-011 · synthetic case ANEM-FX-16

Normocytic anemia and a raised TSH

TSH 11.

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

Purpose: TSH 11.

Inputs the engine received

CBC and reticulocytes

Hemoglobin
11.4 g/dL
Hematocrit
35 %
MCV
90 fL
Reticulocytes
0.9 %

Patient

Age
47 years
Sex
Female

Iron, vitamins and inflammation

Ferritin
90 ng/mL
Transferrin saturation
28 %

Hemolysis, kidney and thyroid

TSH
11 mIU/L

What the engine reports

Detected clinical pattern

Normocytic 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 11.4 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response inadequate (RPI 0.47)

Calculations

Corrected reticulocyte count
0.7%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
0.47

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1The Thyroid Pattern Engine applies the functional-state rules to a raised TSH.
Evidence and rule trace · 5 rules

AN-CALC-01Derived values

Inputs: RPI 0.47

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 11.4 g/dL (<12)

Anemia, mild.

AN-02Morphology by MCV

Inputs: MCV 90 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 0.9% · hematocrit 35% · RPI 0.47

Inadequate marrow response.

AN-19Hypothyroid contribution

Inputs: TSH 11 mIU/L

Hypothyroidism can contribute.

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

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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

Normocytic 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 11.4 g/dL)
  • Morphology: Normocytic (MCV 80–100)
  • Marrow response: Marrow response inadequate (RPI 0.47)

Calculations

Corrected reticulocyte count
0.7%

Reticulocyte % × (hematocrit ÷ 45).

Reticulocyte production index
0.47

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

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1The Thyroid Pattern Engine applies the functional-state rules to a raised TSH.
Evidence and rule trace · 5 rules

AN-CALC-01Derived values

Inputs: RPI 0.47

Derived values calculated.

AN-01Anemia present, with severity

Inputs: hemoglobin 11.4 g/dL (<12)

Anemia, mild.

AN-02Morphology by MCV

Inputs: MCV 90 fL

Normocytic anemia.

AN-03Marrow response

Inputs: retic 0.9% · hematocrit 35% · RPI 0.47

Inadequate marrow response.

AN-19Hypothyroid contribution

Inputs: TSH 11 mIU/L

Hypothyroidism can contribute.

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.

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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