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CPE-011 · synthetic case ANEM-FX-24
Hemolysis markers without a reticulocyte response
A DAT-positive case.
Purpose: A DAT-positive case.
Inputs the engine received
CBC and reticulocytes
- Hemoglobin
- 9.1 g/dL
- Hematocrit
- 28 %
- MCV
- 100 fL
- Reticulocytes
- 1 %
Patient
- Age
- 39 years
- Sex
- Female
Hemolysis, kidney and thyroid
- LDH
- 480 U/L
- Haptoglobin
- 8 mg/dL
- Direct antiglobulin test positive
- Yes
What the engine reports
Detected clinical pattern
Anemia — Pattern Compatible With Hemolysis
Moderate anemia, normocytic. A pattern for physician review; the cause still has to be found.
- Severity: Moderate anemia (Hb 9.1 g/dL)
- Morphology: Normocytic (MCV 80–100)
- Marrow response: Marrow response inadequate (RPI 0.31)
Calculations
- Corrected reticulocyte count
- 0.62%
- Reticulocyte production index
- 0.31
Reticulocyte % × (hematocrit ÷ 45).
Corrected count ÷ maturation factor. 2 or more is an appropriate marrow response.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Direct antiglobulin test, blood film and a search for the cause (autoimmune, mechanical, hereditary, drug, infection).
Missing information
- Ferritin (and transferrin saturation).
Evidence and rule trace · 6 rules
AN-14Hemolysis pattern
Inputs: LDH 480 U/L · haptoglobin 8 mg/dL · direct antiglobulin test positive
Pattern compatible with hemolysis.
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-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.
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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