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CPE-004 · synthetic case IRON-FX-05

Rheumatoid arthritis: ferritin 85, TSAT 12

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

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

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

Inputs the engine received

Iron studies

Ferritin
85 ng/mL
Serum iron
38 µg/dL
TIBC
316 µg/dL
hs-CRP
18 mg/L

CBC

Hemoglobin
10.4 g/dL
MCV
82 fL

Patient

Age
58 years
Sex
Female
Postmenopausal
Yes

Conditions and risk groups

Active inflammation or infection
Yes

What the engine reports

Detected clinical pattern

Possible Inflammation-Associated Iron Restriction

Low transferrin saturation with ferritin raised by inflammation. Anemia of inflammation and combined deficiency cannot be separated from these values.

  • Validity: Ferritin read with inflammation
  • Anemia: Anemia (Hb 10.4 g/dL)

Why this pattern was identified

  • Possible inflammation-associated iron restriction. Ferritin 85 ng/mL with transferrin saturation 12% during inflammation cannot separate anemia of inflammation from combined deficiency.

Calculations

Transferrin saturation
12%

Serum iron ÷ TIBC × 100.

Differentials, pitfalls and contradicting signals

  • Ferritin is an acute-phase reactant: a normal or high value does not exclude iron deficiency while inflammation is present.
  • Anemia of inflammation with or without coexisting absolute iron deficiency: these values cannot tell them apart.
Evidence and rule trace · 4 rules

ID-CALC-01Derived values

Inputs: iron 38, TIBC 316

Derived values calculated.

ID-VAL-01Inflammation changes how ferritin is read

Inputs: inflammation documented · hs-CRP 18 mg/L

Ferritin cutoffs shift; transferrin saturation weighed alongside.

ID-ST-05Inflammation-associated iron restriction possible

Inputs: ferritin 85 ng/mL · TSAT 12% · inflammation

Functional iron restriction possible (anemia of inflammation, with or without absolute deficiency).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 10.4 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

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-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-AHA-HF-2022 · Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.
  • 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

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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

No stage is assigned for the values entered.

Against typical reference intervals

Ferritin85 ng/mL · within reference
ref 30300
MCV82 fL · within reference
ref 80100
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

Possible Inflammation-Associated Iron Restriction

Low transferrin saturation with ferritin raised by inflammation. Anemia of inflammation and combined deficiency cannot be separated from these values.

  • Validity: Ferritin read with inflammation
  • Anemia: Anemia (Hb 10.4 g/dL)

Why this pattern was identified

  • Possible inflammation-associated iron restriction. Ferritin 85 ng/mL with transferrin saturation 12% during inflammation cannot separate anemia of inflammation from combined deficiency.

Calculations

Transferrin saturation
12%

Serum iron ÷ TIBC × 100.

Differentials, pitfalls and contradicting signals

  • Ferritin is an acute-phase reactant: a normal or high value does not exclude iron deficiency while inflammation is present.
  • Anemia of inflammation with or without coexisting absolute iron deficiency: these values cannot tell them apart.
Evidence and rule trace · 4 rules

ID-CALC-01Derived values

Inputs: iron 38, TIBC 316

Derived values calculated.

ID-VAL-01Inflammation changes how ferritin is read

Inputs: inflammation documented · hs-CRP 18 mg/L

Ferritin cutoffs shift; transferrin saturation weighed alongside.

ID-ST-05Inflammation-associated iron restriction possible

Inputs: ferritin 85 ng/mL · TSAT 12% · inflammation

Functional iron restriction possible (anemia of inflammation, with or without absolute deficiency).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 10.4 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

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-CAMASCHELLA-2015 · Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.
  • EV-AHA-HF-2022 · Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. Circulation. 2022;145(18):e895-e1032.
  • 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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Normal CBC, low ferritin, fatigue and hair loss

A 29-year-old with a normal CBC and a ferritin of 18.

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-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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