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CPE-004 · synthetic case IRON-FX-02
Normal CBC, low ferritin, fatigue and hair loss
A 29-year-old with a normal CBC and a ferritin of 18.
Purpose: A 29-year-old with a normal CBC and a ferritin of 18.
Inputs the engine received
Iron studies
- Ferritin
- 18 ng/mL
CBC
- Hemoglobin
- 13.1 g/dL
- MCV
- 88 fL
Patient
- Age
- 29 years
- Sex
- Female
Symptoms and findings
- Fatigue
- Yes
- Diffuse hair loss
- Yes
What the engine reports
Detected clinical pattern
Biochemical Pattern Compatible with Iron Deficiency Without Anemia
An iron-deficiency criterion is met with hemoglobin in range. A normal CBC does not exclude iron deficiency.
- Anemia: No anemia (Hb 13.1 g/dL)
- Stage: Stage 1 · stores depleted
Why this pattern was identified
- Low ferritin (15 to 29 ng/mL). Ferritin 18 ng/mL is below the 30 ng/mL level many guidelines use, even when a laboratory reports it as normal.
Differentials, pitfalls and contradicting signals
- Fatigue, hair loss and restless legs are non-specific; this engine does not attribute them to iron.
- Diffuse hair loss has other causes (thyroid disease, medications, nutritional, postpartum, stress); iron is one contributor.
Evidence and rule trace · 3 rules
ID-ST-02Low ferritin (15 to 29)
Inputs: ferritin 18 ng/mL
Low ferritin: iron deficiency likely in the right context.
ID-12Iron deficiency without anemia
Inputs: hemoglobin 13.1 g/dL · ferritin 18 ng/mL
Biochemical pattern compatible with iron deficiency without anemia (stage 1 or 2).
ID-HAIR-01Diffuse hair loss and ferritin
Inputs: diffuse hair loss · ferritin 18 ng/mL
Ferritin is part of the evaluation of diffuse hair loss.
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-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-ACOG-ANEMIA-2021 · American College of Obstetricians and Gynecologists. Anemia in Pregnancy. ACOG Practice Bulletin No. 233. Obstet Gynecol. 2021;138(2):e55-e64.
- EV-TROST-2006 · Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54(5):824-844.
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 · Stores depleted
Low ferritin, normal CBC
○ 2 · Iron-deficient erythropoiesis
Low TSAT or reticulocyte Hb, Hb still normal
○ 3 · Anemia
Hemoglobin below the WHO threshold
Against typical reference intervals
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
Symptoms and findings
Conditions and risk groups
Work-up and treatment context
More iron cases
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.
IRON-FX-03
Iron-deficiency anemia in a man
A 61-year-old man with Hb 10.9, MCV 76 and a ferritin of 9.
IRON-FX-04
Iron-deficiency anemia after menopause
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
Inflammation with ferritin 48 and TSAT 9
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.
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