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CPE-004 · synthetic case IRON-FX-20
IV iron considered during a urinary infection
Ferritin 14 and an active infection.
Purpose: Ferritin 14 and an active infection.
Inputs the engine received
Iron studies
- Ferritin
- 14 ng/mL
CBC
- Hemoglobin
- 11.5 g/dL
Patient
- Age
- 52 years
- Sex
- Female
Work-up and treatment context
- IV iron under consideration
- Yes
- Active infection
- Yes
What the engine reports
Review the labeling of the specific product and local guidance before intravenous iron during an active infection. This is a review prompt, not a recommendation.
Detected clinical pattern
Biochemical Pattern Compatible with Iron-Deficiency Anemia
Anemia (Hb 11.5 g/dL) with an iron-deficiency criterion met. The cause still has to be found.
- Anemia: Anemia (Hb 11.5 g/dL)
- Stage: Stage 3 · anemia
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.
- 1Establish the source: menstrual loss, gastrointestinal loss, diet or malabsorption.Iron-deficiency anemia is a finding with a cause to find.
- 2Assess menstrual history and heavy menstrual bleeding; consider celiac and H. pylori testing or endoscopy if there is no explanation, GI symptoms or poor response.Heavy menstrual bleeding does not exclude a gastrointestinal source.
- 3Consider celiac serology (tissue transglutaminase IgA with total IgA) and H. pylori testing.AGA 2020; ACG 2023.
Missing information
- MCV (to place the anemia as microcytic, normocytic or macrocytic).
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 11.5 g/dL (<12)
Anemia by WHO hemoglobin thresholds.
ID-11Iron-deficiency anemia pattern
Inputs: hemoglobin 11.5 g/dL · ferritin 14 ng/mL
Biochemical pattern compatible with iron-deficiency anemia (stage 3).
ID-GI-02Premenopausal women: blood-loss assessment
Inputs: premenopausal woman · iron-deficiency anemia pattern
Menstrual blood loss should be quantified; gastrointestinal causes remain possible.
ID-CEL-01Celiac and H. pylori consideration
Inputs: iron-deficiency anemia pattern · celiac serology not documented
Consider celiac serology and H. pylori testing.
ID-IV-01Intravenous iron under consideration with active infection
Inputs: intravenous iron under consideration · active infection
Review product labeling and local guidance on IV iron during active infection.
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.
- EV-IV-LABEL · U.S. Food and Drug Administration. Prescribing information for the specific intravenous iron product (verify current labeling).
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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