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CPE-004 · synthetic case IRON-FX-07
Microcytic anemia with preserved iron indices
MCV 62, RBC 5.6, ferritin 95 and TSAT 28.
Purpose: MCV 62, RBC 5.6, ferritin 95 and TSAT 28.
Inputs the engine received
Iron studies
- Ferritin
- 95 ng/mL
- Serum iron
- 85 µg/dL
- TIBC
- 304 µg/dL
CBC
- Hemoglobin
- 11.2 g/dL
- MCV
- 62 fL
- RDW
- 13.4 %
- RBC count
- 5.6 ×10¹²/L
Patient
- Age
- 24 years
- Sex
- Female
What the engine reports
Detected clinical pattern
Microcytic Anemia With Preserved Iron Indices
Microcytic anemia without an iron-deficiency criterion. A low Mentzer index favors thalassemia trait; confirmation needs hemoglobin electrophoresis.
- Anemia: Anemia (Hb 11.2 g/dL)
Calculations
- Transferrin saturation
- 28%
- Mentzer index
- 11.1
Serum iron ÷ TIBC × 100.
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.
- 1If the Mentzer index is below 13 and iron indices are not deficient, consider hemoglobin electrophoresis.
Differentials, pitfalls and contradicting signals
- Thalassemia trait: Mentzer index below 13 with preserved iron indices. Consider hemoglobin electrophoresis.
Evidence and rule trace · 3 rules
ID-AN-01Anemia present by WHO thresholds
Inputs: hemoglobin 11.2 g/dL (<12)
Anemia by WHO hemoglobin thresholds.
ID-14Microcytic anemia differential
Inputs: MCV 62 fL · hemoglobin 11.2 g/dL · Mentzer 11.1
Microcytic anemia differential compared.
Evidence
- 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-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
No stage is assigned for the values entered.
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-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.
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