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CPE-009 · Safety
B12-15: Severe or hemolytic picture
Severe or hemolytic picture. Evaluates pancytopenia OR hemoglobin below 7 g/dL OR schistocytes with raised LDH and low haptoglobin.
Condition
- pancytopenia OR hemoglobin < 7 g/dL OR schistocytes with raised LDH and low haptoglobin
- with macrocytosis, or low or borderline B12, or low folate
What it reports
- Urgent hematology review: severe megaloblastic anemia can mimic thrombotic microangiopathy
Diagnostic boundary
- Routine outpatient pathway is not appropriate.
Evidence
- EV-BSH-2014Devalia 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.Supports: Diagnostic approach with serum B12, MMA and homocysteine Neurologic involvement means treatment should not wait for confirmation Folic acid alone must not be given while B12 deficiency is unexcluded
- EV-STABLER-2013Stabler SP. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160.Supports: Clinical presentations, subacute combined degeneration, nitrous oxide and drug causes
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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