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CPE-004 · synthetic case IRON-FX-14
Anemia with overt gastrointestinal bleeding
Black stools and Hb 8.9.
Purpose: Black stools and Hb 8.9.
Inputs the engine received
Iron studies
- Ferritin
- 14 ng/mL
CBC
- Hemoglobin
- 8.9 g/dL
- MCV
- 80 fL
Patient
- Age
- 72 years
- Sex
- Male
Symptoms and findings
- Melena, hematochezia or hematemesis
- Yes
What the engine reports
Overt bleeding signs with anemia or iron deficiency need prompt clinical assessment, not the routine outpatient iron-deficiency pathway.
Iron-deficiency anemia in a man needs a gastrointestinal source considered. AGA 2020 suggests bidirectional endoscopy for asymptomatic men and postmenopausal women. The evaluation is the physician's decision.
Detected clinical pattern
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first; the laboratory pattern is shown below them.
- Anemia: Anemia (Hb 8.9 g/dL)
- Stage: Stage 3 · anemia
- Pattern: iron deficiency anemia pattern
Why this pattern was identified
- Ferritin below 15 ng/mL. Ferritin 14 ng/mL meets the WHO criterion for iron deficiency.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Urgent assessment of a possible active gastrointestinal bleed.
- 2Consider bidirectional endoscopy and review colorectal cancer screening status (AGA 2020).Men and postmenopausal women with iron-deficiency anemia.
- 3Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
- 4Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.
Evidence and rule trace · 6 rules
ID-ST-01Iron stores depleted (ferritin below 15)
Inputs: ferritin 14 ng/mL
Iron stores depleted: absolute iron-deficiency criterion met (WHO).
ID-AN-01Anemia present by WHO thresholds
Inputs: hemoglobin 8.9 g/dL (<13)
Anemia by WHO hemoglobin thresholds.
ID-11Iron-deficiency anemia pattern
Inputs: hemoglobin 8.9 g/dL · ferritin 14 ng/mL
Biochemical pattern compatible with iron-deficiency anemia (stage 3).
ID-SAFE-02Overt gastrointestinal bleeding signs
Inputs: melena, hematochezia or hematemesis documented · hemoglobin 8.9 g/dL
Urgent clinical assessment: possible active gastrointestinal bleeding.
ID-GI-01Gastrointestinal evaluation: men and postmenopausal women
Inputs: male · iron-deficiency anemia pattern
Priority review: gastrointestinal source to be considered.
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-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.
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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