Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.
CPE-009 · synthetic case B12-FX-21
Schistocytes with raised LDH in a macrocytic anemia
Hemolytic features.
Purpose: Hemolytic features.
Inputs the engine received
Laboratory
- Serum vitamin B12
- 180 pg/mL
- MCV
- 105 fL
- Hemoglobin
- 8.2 g/dL
- Schistocytes with raised LDH and low haptoglobin
- Yes
Patient
- Age
- 64 years
- Sex
- Male
What the engine reports
A severe megaloblastic anemia can mimic thrombotic microangiopathy. Urgent hematology review is needed; the routine outpatient pathway is not appropriate.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- B12 level: B12 180 pg/mL · low
- Pattern: b12 deficiency pattern
Why this pattern was identified
- Low serum B12. 180 pg/mL is below 200 pg/mL (148 pmol/L).
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent hematology review.
- 2Look for the cause: pernicious anemia, diet, drugs (metformin, acid suppression, nitrous oxide) and malabsorption.
- 3Check B12 and folate, a reticulocyte count and a blood film; review alcohol, liver and thyroid status and drugs.
- 4Consider intrinsic-factor antibodies.
Differentials, pitfalls and contradicting signals
- Macrocytosis has many causes beyond B12 and folate: alcohol, liver disease, hypothyroidism, reticulocytosis, myelodysplasia and drugs (hydroxyurea, methotrexate, zidovudine, azathioprine).
Evidence and rule trace · 4 rules
B12-01Low serum B12
Inputs: serum B12 180 pg/mL (<200)
Biochemical pattern compatible with vitamin B12 deficiency.
B12-08Pernicious anemia evaluation
Inputs: age 64 · anti-intrinsic factor not done
Pernicious anemia evaluation.
B12-15Severe or hemolytic picture
Inputs: schistocytes with raised LDH and low haptoglobin
Urgent hematology review.
Evidence
- EV-BSH-2014 · Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014;166(4):496-513.
- EV-STABLER-2013 · Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.
- EV-GREEN-2017 · Green R, Allen LH, Bjørke-Monsen AL, et al. Vitamin B12 deficiency. Nat Rev Dis Primers. 2017;3:17040.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety considerations. It does not diagnose, find the cause, or select a vitamin product, dose or route. 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.
Serum B12 level
● Below 200 pg/mL
Deficiency pattern
○ 200 to 300 pg/mL
Borderline: MMA and homocysteine settle it
○ Above 300 pg/mL
Deficiency unlikely, not excluded
Laboratory
- <200
- 200–300
- >300
Patient
Neurologic features
Drugs, diet and risk groups
More b12 cases
B12-FX-01
B12 of 150 pg/mL with macrocytic anemia
A 67-year-old with MCV 108.
B12-FX-02
Borderline B12 with raised MMA
B12 260 and MMA 0.52.
B12-FX-03
Borderline B12 and no confirmatory test
B12 250.
B12-FX-04
Macrocytic anemia, folic acid ordered, no B12
A safety situation.
B12-FX-05
Neuropathy, B12 220 and metformin for five years
Neurologic features with a borderline level.
B12-FX-06
Posterior-column signs and spasticity
A pattern compatible with subacute combined degeneration.
Try Biod in your practice
The Clinical Intelligence Layer — transforming fragmented clinical information into structured intelligence for clinician review and action.