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CPE-004 · synthetic case 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.
Purpose: A 61-year-old man with Hb 10.9, MCV 76 and a ferritin of 9.
Inputs the engine received
Iron studies
- Ferritin
- 9 ng/mL
- Serum iron
- 31 µg/dL
- TIBC
- 410 µg/dL
CBC
- Hemoglobin
- 10.9 g/dL
- MCV
- 76 fL
- RDW
- 16.2 %
Patient
- Age
- 61 years
- Sex
- Male
What the engine reports
Iron-deficiency anemia in a man needs a gastrointestinal source considered. AGA 2020 suggests bidirectional endoscopy for asymptomatic men and postmenopausal women. The evaluation is the physician's decision.
Detected clinical pattern
Biochemical Pattern Compatible with Iron-Deficiency Anemia
Anemia (Hb 10.9 g/dL) with an iron-deficiency criterion met. The cause still has to be found.
- Anemia: Anemia (Hb 10.9 g/dL)
- Stage: Stage 3 · anemia
Why this pattern was identified
- Ferritin below 15 ng/mL. Ferritin 9 ng/mL meets the WHO criterion for iron deficiency.
- Supportive indices. MCV 76 fL; RDW 16.2%; TSAT 7.6% are consistent with iron-limited red-cell production.
Calculations
- Transferrin saturation
- 7.6%
Serum iron ÷ TIBC × 100.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Consider bidirectional endoscopy and review colorectal cancer screening status (AGA 2020).Men and postmenopausal women with iron-deficiency anemia.
- 2Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
- 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-ST-01Iron stores depleted (ferritin below 15)
Inputs: ferritin 9 ng/mL
Iron stores depleted: absolute iron-deficiency criterion met (WHO).
ID-AN-01Anemia present by WHO thresholds
Inputs: hemoglobin 10.9 g/dL (<13)
Anemia by WHO hemoglobin thresholds.
ID-11Iron-deficiency anemia pattern
Inputs: hemoglobin 10.9 g/dL · ferritin 9 ng/mL · MCV 76 fL · RDW 16.2% · TSAT 7.6%
Biochemical pattern compatible with iron-deficiency anemia (stage 3).
ID-14Microcytic anemia differential
Inputs: MCV 76 fL · hemoglobin 10.9 g/dL
Microcytic anemia differential compared.
ID-GI-01Gastrointestinal evaluation: men and postmenopausal women
Inputs: male · iron-deficiency anemia pattern
Priority review: gastrointestinal source to be considered.
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 · 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-02
Normal CBC, low ferritin, fatigue and hair loss
A 29-year-old with a normal CBC and a ferritin of 18.
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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