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CPE-004 · synthetic case IRON-FX-10
Heart failure and no iron studies
A patient with heart failure and no ferritin or saturation on file.
Purpose: A patient with heart failure and no ferritin or saturation on file.
Inputs the engine received
CBC
- Hemoglobin
- 12.8 g/dL
Patient
- Age
- 68 years
- Sex
- Female
- Postmenopausal
- Yes
Conditions and risk groups
- Heart failure
- Yes
What the engine reports
Detected clinical pattern
Insufficient Data to Classify Iron Status
Ferritin is needed. Add it, with transferrin saturation when inflammation, heart failure or CKD is present.
- Anemia: No anemia (Hb 12.8 g/dL)
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Consider ferritin and transferrin saturation: iron deficiency is common in heart failure and has a guideline definition.
Missing information
- Ferritin (required to classify iron status).
Evidence and rule trace · 2 rules
ID-HF-01Heart failure without iron studies
Inputs: heart failure · ferritin missing
Iron status not assessed in heart failure.
ID-MISS-01Core iron studies missing
Inputs: ferritin missing
Iron status cannot be classified with the data entered.
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-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.
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.
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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