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CPE-004 · synthetic case IRON-FX-15
Ferritin 780 with transferrin saturation 71%
A 45-year-old man with high saturation and high ferritin.
Purpose: A 45-year-old man with high saturation and high ferritin.
Inputs the engine received
Iron studies
- Ferritin
- 780 ng/mL
- Serum iron
- 190 µg/dL
- TIBC
- 267 µg/dL
CBC
- Hemoglobin
- 15.1 g/dL
Patient
- Age
- 45 years
- Sex
- Male
What the engine reports
Transferrin saturation 71.2% with ferritin 780 ng/mL. Repeat on a fasting morning sample and consider HFE genotyping per EASL 2022. This is not a diagnosis of hemochromatosis.
Detected clinical pattern
Pattern Raising the Possibility of Iron Overload
High transferrin saturation with high ferritin. Not a diagnosis of hemochromatosis; repeat and consider HFE genotyping.
- Anemia: No anemia (Hb 15.1 g/dL)
Calculations
- Transferrin saturation
- 71.2%
Serum iron ÷ TIBC × 100.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Repeat transferrin saturation and ferritin on a fasting morning sample; physician to consider HFE genotyping (EASL 2022).
Differentials, pitfalls and contradicting signals
- Liver disease, hemolysis, recent iron intake and inflammation can raise both ferritin and saturation.
Evidence and rule trace · 2 rules
ID-OV-01Iron-overload pattern
Inputs: TSAT 71.2% · ferritin 780 ng/mL (>300)
Pattern that raises the possibility of iron overload.
Evidence
- EV-EASL-HFE-2022 · European Association for the Study of the Liver. EASL Clinical Practice Guidelines on haemochromatosis. J Hepatol. 2022;77(2):479-502.
- 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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