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CPE-004 · Anemia
ID-14: Microcytic anemia differential
Microcytic anemia differential. Evaluates anemia present.
Condition
- anemia present
- MCV < 80 fL
What it reports
- Iron deficiency, anemia of inflammation, thalassemia trait and sideroblastic anemia are compared on ferritin, transferrin saturation, RDW and the Mentzer index (MCV ÷ RBC)
Recommended next steps (for physician review)
- If the Mentzer index is below 13 and iron indices are not deficient, consider hemoglobin electrophoresis
Diagnostic boundary
- The Mentzer index screens; it does not establish thalassemia.
Evidence
- EV-CAMASCHELLA-2015Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832-1843.Supports: Stages of iron deficiency, causes and differential diagnosis of microcytic anemia
- EV-MENTZER-1973Mentzer WC Jr. Differentiation of iron deficiency from thalassaemia trait. Lancet. 1973;1(7808):882.Supports: MCV ÷ RBC count below 13 favors thalassemia trait; above 13 favors iron deficiency
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
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-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-06
Inflammation with ferritin 48 and TSAT 9
Ferritin looks near normal but sits under the WHO inflammation cutoff of 70.
IRON-FX-07
Microcytic anemia with preserved iron indices
MCV 62, RBC 5.6, ferritin 95 and TSAT 28.
IRON-FX-13
Severe anemia
Hemoglobin 6.4 g/dL with a ferritin of 4.
IRON-FX-17
Iron-deficiency anemia in pregnancy
A pregnant woman with Hb 10.2 and a ferritin of 11.
IRON-FX-18
Four months of oral iron without response
Adherent for four months, ferritin still 12.
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