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CPE-004 · synthetic case IRON-FX-16
Ferritin 1,450 during inflammation
A very high ferritin with a CRP of 60.
Purpose: A very high ferritin with a CRP of 60.
Inputs the engine received
Iron studies
- Ferritin
- 1450 ng/mL
- Serum iron
- 55 µg/dL
- TIBC
- 220 µg/dL
- hs-CRP
- 60 mg/L
CBC
- Hemoglobin
- 11.9 g/dL
Patient
- Age
- 55 years
- Sex
- Male
What the engine reports
Ferritin 1450 ng/mL has several serious causes: iron overload, hepatocellular injury, hemolysis, malignancy, macrophage activation and inflammation.
Detected clinical pattern
Anemia Without an Iron-Deficiency Criterion
Hemoglobin is below threshold and no iron-deficiency criterion is met with the values entered. Other causes of anemia remain open.
- Validity: Ferritin read with inflammation
- Anemia: Anemia (Hb 11.9 g/dL)
Calculations
- Transferrin saturation
- 25%
Serum iron ÷ TIBC × 100.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Physician review of the cause of very high ferritin.
Differentials, pitfalls and contradicting signals
- Ferritin is an acute-phase reactant: a normal or high value does not exclude iron deficiency while inflammation is present.
Missing information
- MCV (to place the anemia as microcytic, normocytic or macrocytic).
Evidence and rule trace · 4 rules
ID-VAL-01Inflammation changes how ferritin is read
Inputs: hs-CRP 60 mg/L
Ferritin cutoffs shift; transferrin saturation weighed alongside.
ID-AN-01Anemia present by WHO thresholds
Inputs: hemoglobin 11.9 g/dL (<13)
Anemia by WHO hemoglobin thresholds.
ID-OV-02Very high ferritin
Inputs: ferritin 1450 ng/mL
Priority review: very high ferritin has several serious causes.
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-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-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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