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CPE-004 · synthetic case IRON-FX-01

Classic iron-deficiency anemia in a premenopausal woman

A 34-year-old with heavy periods, Hb 9.8, MCV 72 and a ferritin of 6.

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

Purpose: A 34-year-old with heavy periods, Hb 9.8, MCV 72 and a ferritin of 6.

Inputs the engine received

Iron studies

Ferritin
6 ng/mL
Serum iron
28 µg/dL
TIBC
460 µg/dL

CBC

Hemoglobin
9.8 g/dL
MCV
72 fL
RDW
17.1 %
RBC count
4.9 ×10¹²/L

Patient

Age
34 years
Sex
Female

Symptoms and findings

Fatigue
Yes

Conditions and risk groups

Heavy menstrual bleeding
Yes

What the engine reports

Detected clinical pattern

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 9.8 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Anemia: Anemia (Hb 9.8 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Ferritin below 15 ng/mL. Ferritin 6 ng/mL meets the WHO criterion for iron deficiency.
  • Supportive indices. MCV 72 fL; RDW 17.1%; TSAT 6.1% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
6.1%

Serum iron ÷ TIBC × 100.

Mentzer index
14.7

MCV ÷ RBC count. Below 13 favors thalassemia trait; above 13 favors iron deficiency. A screen, not a diagnosis.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
  2. 2Assess menstrual history and heavy menstrual bleeding; consider celiac and H. pylori testing or endoscopy if there is no explanation, GI symptoms or poor response.Heavy menstrual bleeding does not exclude a gastrointestinal source.
  3. 3Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.

Differentials, pitfalls and contradicting signals

  • Iron deficiency: low ferritin or low transferrin saturation with high RDW.
Evidence and rule trace · 7 rules

ID-CALC-01Derived values

Inputs: iron 28, TIBC 460 · MCV 72, RBC 4.9

Derived values calculated.

ID-ST-01Iron stores depleted (ferritin below 15)

Inputs: ferritin 6 ng/mL

Iron stores depleted: absolute iron-deficiency criterion met (WHO).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 9.8 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 9.8 g/dL · ferritin 6 ng/mL · MCV 72 fL · RDW 17.1% · TSAT 6.1%

Biochemical pattern compatible with iron-deficiency anemia (stage 3).

ID-14Microcytic anemia differential

Inputs: MCV 72 fL · hemoglobin 9.8 g/dL · Mentzer 14.7

Microcytic anemia differential compared.

ID-GI-02Premenopausal women: blood-loss assessment

Inputs: premenopausal woman · iron-deficiency anemia pattern

Menstrual blood loss should be quantified; gastrointestinal causes remain possible.

ID-CEL-01Celiac and H. pylori consideration

Inputs: iron-deficiency anemia pattern · celiac serology not documented

Consider celiac serology and H. pylori testing.

Evidence

  • EV-WHO-FERR-2020 · World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.
  • EV-WHO-HB-2011 · World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
  • EV-AGA-2020 · Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020;159(3):1085-1094.
  • EV-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-LOPEZ-2016 · Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-916.
  • EV-ACG-CELIAC-2023 · Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2023;118(1):59-76.
  • 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 identifies laboratory patterns and safety considerations. It does not diagnose, find a cause, or select an iron 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.

Stage of iron deficiency

  1. ✓ 1 · Stores depleted

    Low ferritin, normal CBC

  2. ✓ 2 · Iron-deficient erythropoiesis

    Low TSAT or reticulocyte Hb, Hb still normal

  3. ● 3 · Anemia

    Hemoglobin below the WHO threshold

Against typical reference intervals

Ferritin6 ng/mL · below reference
ref 30300
MCV72 fL · below reference
ref 80100
RDW17.1 % · above reference
ref 11.514.5
Iron studiesDrag or type
  • <15 depleted
  • 15–29 low
  • 30–44 borderline
  • 45–299
  • 300–999 high
  • >1000 very high

Calculated from iron ÷ TIBC when both are entered.

Above 5 mg/L the engine reads ferritin as inflammation-affected.

CBC
  • <7 severe
  • 7–11.9 anemia range
  • 12–12.9 (men <13)
  • ≥13
Patient
Sex
Symptoms and findings
Conditions and risk groups
Work-up and treatment context

Live result · computed in your browser

Detected clinical pattern

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 9.8 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Anemia: Anemia (Hb 9.8 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Ferritin below 15 ng/mL. Ferritin 6 ng/mL meets the WHO criterion for iron deficiency.
  • Supportive indices. MCV 72 fL; RDW 17.1%; TSAT 6.1% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
6.1%

Serum iron ÷ TIBC × 100.

Mentzer index
14.7

MCV ÷ RBC count. Below 13 favors thalassemia trait; above 13 favors iron deficiency. A screen, not a diagnosis.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
  2. 2Assess menstrual history and heavy menstrual bleeding; consider celiac and H. pylori testing or endoscopy if there is no explanation, GI symptoms or poor response.Heavy menstrual bleeding does not exclude a gastrointestinal source.
  3. 3Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.

Differentials, pitfalls and contradicting signals

  • Iron deficiency: low ferritin or low transferrin saturation with high RDW.
Evidence and rule trace · 7 rules

ID-CALC-01Derived values

Inputs: iron 28, TIBC 460 · MCV 72, RBC 4.9

Derived values calculated.

ID-ST-01Iron stores depleted (ferritin below 15)

Inputs: ferritin 6 ng/mL

Iron stores depleted: absolute iron-deficiency criterion met (WHO).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 9.8 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 9.8 g/dL · ferritin 6 ng/mL · MCV 72 fL · RDW 17.1% · TSAT 6.1%

Biochemical pattern compatible with iron-deficiency anemia (stage 3).

ID-14Microcytic anemia differential

Inputs: MCV 72 fL · hemoglobin 9.8 g/dL · Mentzer 14.7

Microcytic anemia differential compared.

ID-GI-02Premenopausal women: blood-loss assessment

Inputs: premenopausal woman · iron-deficiency anemia pattern

Menstrual blood loss should be quantified; gastrointestinal causes remain possible.

ID-CEL-01Celiac and H. pylori consideration

Inputs: iron-deficiency anemia pattern · celiac serology not documented

Consider celiac serology and H. pylori testing.

Evidence

  • EV-WHO-FERR-2020 · World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.
  • EV-WHO-HB-2011 · World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
  • EV-AGA-2020 · Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020;159(3):1085-1094.
  • EV-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-LOPEZ-2016 · Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-916.
  • EV-ACG-CELIAC-2023 · Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. Am J Gastroenterol. 2023;118(1):59-76.
  • 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 identifies laboratory patterns and safety considerations. It does not diagnose, find a cause, or select an iron product, dose or route. Physician adjudication is required.

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IRON-FX-04

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A 67-year-old woman, postmenopausal, Hb 10.6, ferritin 11.

IRON-FX-05

Rheumatoid arthritis: ferritin 85, TSAT 12

Hb 10.4 with a ferritin that looks normal and a CRP of 18.

IRON-FX-06

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Ferritin looks near normal but sits under the WHO inflammation cutoff of 70.

IRON-FX-07

Microcytic anemia with preserved iron indices

MCV 62, RBC 5.6, ferritin 95 and TSAT 28.

All iron cases

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