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CPE-004 · synthetic case IRON-FX-08
Heart failure with ferritin 82
A 70-year-old man with heart failure and a normal hemoglobin.
Purpose: A 70-year-old man with heart failure and a normal hemoglobin.
Inputs the engine received
Iron studies
- Ferritin
- 82 ng/mL
- Serum iron
- 70 µg/dL
- TIBC
- 290 µg/dL
CBC
- Hemoglobin
- 13.4 g/dL
Patient
- Age
- 70 years
- Sex
- Male
Conditions and risk groups
- Heart failure
- 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 13.4 g/dL)
- Stage: Stage 1 · stores depleted
Why this pattern was identified
- Heart-failure iron deficiency. Ferritin 82 ng/mL meets the heart-failure definition (ferritin <100, or 100–299 with TSAT <20%).
Calculations
- Transferrin saturation
- 24.1%
Serum iron ÷ TIBC × 100.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Physician to review the heart-failure iron-repletion pathway.AHA/ACC/HFSA 2022.
Differentials, pitfalls and contradicting signals
- Fatigue, hair loss and restless legs are non-specific; this engine does not attribute them to iron.
Evidence and rule trace · 3 rules
ID-ST-06Heart-failure iron deficiency criterion
Inputs: ferritin 82 ng/mL · TSAT 24.1% · heart failure
Iron deficiency by the AHA/ACC/HFSA heart-failure definition.
ID-12Iron deficiency without anemia
Inputs: hemoglobin 13.4 g/dL · ferritin 82 ng/mL
Biochemical pattern compatible with iron deficiency without anemia (stage 1 or 2).
Evidence
- 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-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-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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