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CPE-004 · synthetic case IRON-FX-25

Iron-deficient erythropoiesis before anemia

Hb 12.4 but TSAT 11% and reticulocyte Hb 25 pg.

Synthetic · no real patientAuthored by Biod · reviewed by Dr. AmaralIron engine v1.0.0

Purpose: Hb 12.4 but TSAT 11% and reticulocyte Hb 25 pg.

Inputs the engine received

Iron studies

Ferritin
14 ng/mL
Serum iron
30 µg/dL
TIBC
273 µg/dL
Reticulocyte hemoglobin
25 pg

CBC

Hemoglobin
12.4 g/dL
MCV
83 fL

Patient

Age
33 years
Sex
Female

What the engine reports

Detected clinical pattern

Biochemical Pattern Compatible with Iron Deficiency Without Anemia

An iron-deficiency criterion is met with hemoglobin in range. A normal CBC does not exclude iron deficiency.

  • Anemia: No anemia (Hb 12.4 g/dL)
  • Stage: Stage 2 · iron-deficient erythropoiesis

Why this pattern was identified

  • Ferritin below 15 ng/mL. Ferritin 14 ng/mL meets the WHO criterion for iron deficiency.

Calculations

Transferrin saturation
11%

Serum iron ÷ TIBC × 100.

Differentials, pitfalls and contradicting signals

  • Fatigue, hair loss and restless legs are non-specific; this engine does not attribute them to iron.
Evidence and rule trace · 4 rules

ID-CALC-01Derived values

Inputs: iron 30, TIBC 273

Derived values calculated.

ID-ST-01Iron stores depleted (ferritin below 15)

Inputs: ferritin 14 ng/mL

Iron stores depleted: absolute iron-deficiency criterion met (WHO).

ID-12Iron deficiency without anemia

Inputs: hemoglobin 12.4 g/dL · ferritin 14 ng/mL

Biochemical pattern compatible with iron deficiency without anemia (stage 1 or 2).

ID-13Iron-deficient erythropoiesis

Inputs: TSAT 11% · reticulocyte Hb 25 pg

Stage 2: iron supply to the marrow is becoming limiting before hemoglobin falls.

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-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-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.

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Stage of iron deficiency

  1. ✓ 1 · Stores depleted

    Low ferritin, normal CBC

  2. ● 2 · Iron-deficient erythropoiesis

    Low TSAT or reticulocyte Hb, Hb still normal

  3. ○ 3 · Anemia

    Hemoglobin below the WHO threshold

Against typical reference intervals

Ferritin14 ng/mL · below reference
ref 30300
MCV83 fL · within reference
ref 80100
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
Sex
Symptoms and findings
Conditions and risk groups
Work-up and treatment context

Live result · computed in your browser

Detected clinical pattern

Biochemical Pattern Compatible with Iron Deficiency Without Anemia

An iron-deficiency criterion is met with hemoglobin in range. A normal CBC does not exclude iron deficiency.

  • Anemia: No anemia (Hb 12.4 g/dL)
  • Stage: Stage 2 · iron-deficient erythropoiesis

Why this pattern was identified

  • Ferritin below 15 ng/mL. Ferritin 14 ng/mL meets the WHO criterion for iron deficiency.

Calculations

Transferrin saturation
11%

Serum iron ÷ TIBC × 100.

Differentials, pitfalls and contradicting signals

  • Fatigue, hair loss and restless legs are non-specific; this engine does not attribute them to iron.
Evidence and rule trace · 4 rules

ID-CALC-01Derived values

Inputs: iron 30, TIBC 273

Derived values calculated.

ID-ST-01Iron stores depleted (ferritin below 15)

Inputs: ferritin 14 ng/mL

Iron stores depleted: absolute iron-deficiency criterion met (WHO).

ID-12Iron deficiency without anemia

Inputs: hemoglobin 12.4 g/dL · ferritin 14 ng/mL

Biochemical pattern compatible with iron deficiency without anemia (stage 1 or 2).

ID-13Iron-deficient erythropoiesis

Inputs: TSAT 11% · reticulocyte Hb 25 pg

Stage 2: iron supply to the marrow is becoming limiting before hemoglobin falls.

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-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-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.

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.

All iron cases

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