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CPE-004 · synthetic case IRON-FX-06

Inflammation with ferritin 48 and TSAT 9

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

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

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

Inputs the engine received

Iron studies

Ferritin
48 ng/mL
Serum iron
27 µg/dL
TIBC
300 µg/dL
hs-CRP
12 mg/L

CBC

Hemoglobin
10.8 g/dL
MCV
77 fL

Patient

Age
49 years
Sex
Female

What the engine reports

Detected clinical pattern

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 10.8 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Validity: Ferritin read with inflammation
  • Anemia: Anemia (Hb 10.8 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Iron deficiency likely despite inflammation. Ferritin 48 ng/mL is under the WHO cutoff of 70 ng/mL that applies when inflammation is present; transferrin saturation 9%.
  • Supportive indices. MCV 77 fL; TSAT 9% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
9%

Serum iron ÷ TIBC × 100.

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

  • Ferritin is an acute-phase reactant: a normal or high value does not exclude iron deficiency while inflammation is present.
  • Iron deficiency: low ferritin or low transferrin saturation with high RDW.
Evidence and rule trace · 8 rules

ID-CALC-01Derived values

Inputs: iron 27, TIBC 300

Derived values calculated.

ID-VAL-01Inflammation changes how ferritin is read

Inputs: hs-CRP 12 mg/L

Ferritin cutoffs shift; transferrin saturation weighed alongside.

ID-ST-04Iron deficiency likely despite inflammation

Inputs: ferritin 48 ng/mL · TSAT 9%

Iron deficiency likely coexisting with inflammation (WHO ferritin cutoff <70 ng/mL).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 10.8 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 10.8 g/dL · ferritin 48 ng/mL · MCV 77 fL · TSAT 9%

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

ID-14Microcytic anemia differential

Inputs: MCV 77 fL · hemoglobin 10.8 g/dL

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-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-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

Ferritin48 ng/mL · within reference
ref 30300
MCV77 fL · below 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

Biochemical Pattern Compatible with Iron-Deficiency Anemia

Anemia (Hb 10.8 g/dL) with an iron-deficiency criterion met. The cause still has to be found.

  • Validity: Ferritin read with inflammation
  • Anemia: Anemia (Hb 10.8 g/dL)
  • Stage: Stage 3 · anemia

Why this pattern was identified

  • Iron deficiency likely despite inflammation. Ferritin 48 ng/mL is under the WHO cutoff of 70 ng/mL that applies when inflammation is present; transferrin saturation 9%.
  • Supportive indices. MCV 77 fL; TSAT 9% are consistent with iron-limited red-cell production.

Calculations

Transferrin saturation
9%

Serum iron ÷ TIBC × 100.

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

  • Ferritin is an acute-phase reactant: a normal or high value does not exclude iron deficiency while inflammation is present.
  • Iron deficiency: low ferritin or low transferrin saturation with high RDW.
Evidence and rule trace · 8 rules

ID-CALC-01Derived values

Inputs: iron 27, TIBC 300

Derived values calculated.

ID-VAL-01Inflammation changes how ferritin is read

Inputs: hs-CRP 12 mg/L

Ferritin cutoffs shift; transferrin saturation weighed alongside.

ID-ST-04Iron deficiency likely despite inflammation

Inputs: ferritin 48 ng/mL · TSAT 9%

Iron deficiency likely coexisting with inflammation (WHO ferritin cutoff <70 ng/mL).

ID-AN-01Anemia present by WHO thresholds

Inputs: hemoglobin 10.8 g/dL (<12)

Anemia by WHO hemoglobin thresholds.

ID-11Iron-deficiency anemia pattern

Inputs: hemoglobin 10.8 g/dL · ferritin 48 ng/mL · MCV 77 fL · TSAT 9%

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

ID-14Microcytic anemia differential

Inputs: MCV 77 fL · hemoglobin 10.8 g/dL

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-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-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.

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-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-07

Microcytic anemia with preserved iron indices

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

All iron cases

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