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CPE-004 · Iron status
ID-ST-01: Iron stores depleted (ferritin below 15)
Iron stores depleted (ferritin below 15). Evaluates ferritin below 15 ng/mL.
Condition
- ferritin < 15 ng/mL
- no inflammation or CRP elevation changing the cutoff
What it reports
- Iron stores depleted: absolute iron deficiency criterion met (WHO)
Recommended next steps (for physician review)
- Look for the cause: blood loss, diet, absorption and increased demand
- Complete iron studies and a CBC if not recent
Diagnostic boundary
- A criterion for iron deficiency, not a statement about its cause.
Evidence
- EV-WHO-FERR-2020World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: WHO; 2020.Supports: Ferritin below 15 µg/L indicates iron deficiency in healthy adults A higher cutoff (<70 µg/L) applies in the presence of infection or inflammation
- 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
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-13
Severe anemia
Hemoglobin 6.4 g/dL with a ferritin of 4.
IRON-FX-14
Anemia with overt gastrointestinal bleeding
Black stools and Hb 8.9.
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.
IRON-FX-20
IV iron considered during a urinary infection
Ferritin 14 and an active infection.
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