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Orrin Treadwell: Acute blood loss anaemia
ENC-00016 · 64F · Hospital Medicine · admitted Fri Nov 06, 2026 02:51 PM · discharged Wed Nov 11, 2026 02:58 PM · attending Dr. Jalen Carrow · resident Dr. Keira Upfield
Clinical judgement required: Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL).
Documented vs supported
- Documented
- “acute blood loss anemia” · D62 Acute posthemorrhagic anemia
- Criteria support
- no conclusion: clinical judgement required
- Outcome
- Haemoglobin fell 1.4 g/dL without transfusion (between 1 and 2 g/dL)
- Rule
- Acute blood loss anaemia v2026.11-1
- Published source
- WHO guideline on haemoglobin cutoffs to define anaemia in individuals and populations (2024), Adult cut-offs: men <13 g/dL, non-pregnant women <12 g/dL (unchanged from 2011) · source (checked 2026-11-14)
- Contested
- There is no published clinical definition of "acute blood loss anaemia". This rule is a LOCAL CONVENTION: WHO anaemia threshold at the nadir, a documented bleeding source, and an acute fall of >=2 g/dL OR >=2 units transfused (borrowed from the ISTH major-bleeding definition, which secondary restatements word inconsistently as AND/OR).
Clinical judgement required. The rule does not conclude here. A CDI specialist may send an open query or dismiss the finding; nothing is proposed as fact.
Effect if the clinician agrees (illustrative)
- Change
- no projected change (clinician judgement)
- Secondary-diagnosis level
- CC → —
- MS-DRG (illustrative)
- 690 Kidney and urinary tract infections without MCC → 690 Kidney and urinary tract infections without MCC
- Relative weight
- 0.8095 → 0.8095 (+0.0000)
- Codes before
- N39.0, D62, I10
- Codes after
- N39.0, D62, I10
All open gaps on this encounter together: MS-DRG 690 → 690 (RW +0.0000). The grouping does not change; the record becomes accurate.
CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.
Severity documentation index change SIMULATED
0.0 points
SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.
Evidence
Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.
| Input | Value | Source |
|---|---|---|
| Sex | F |
sex F
|
| First haemoglobin this stay (g/dL) | 11.21 |
hemoglobin 11.21 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 9.81 |
hemoglobin 9.81 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
1.4 |
hemoglobin 11.21
hemoglobin 9.81
|
| Red cell units transfused | 0 | derived (no source row) |
Rule trace (inputs, thresholds, outcome)
| Step | Expression | Inputs and thresholds read | Result |
|---|---|---|---|
| derived: anaemic | case(sex == 'M', hgb_nadir < t.hb_m, sex == 'F', hgb_nadir < t.hb_f, null) |
hgb_nadir=9.81, sex=F, t.hb_f=12, t.hb_m=13 | true |
| derived: acute_fall | hgb_drop >= t.drop_major or prbc_units >= t.prbc_major |
hgb_drop=1.4, prbc_units=0, t.drop_major=2.0, t.prbc_major=2 | false |
| outcome: met | bleeding_documented and anaemic and acute_fall |
acute_fall=False, anaemic=True, bleeding_documented=False | false |
| outcome: anaemia_only | anaemic and hgb_drop < t.drop_min and prbc_units == 0 |
anaemic=True, hgb_drop=1.4, prbc_units=0, t.drop_min=1.0 | false |
| outcome: not_anaemic | present(hgb_nadir) and not anaemic |
anaemic=True, hgb_nadir=9.81 | false |
| outcome: no_source | anaemic and acute_fall |
acute_fall=False, anaemic=True | false |
| outcome: borderline | anaemic |
anaemic=True | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #1981); clinical indicators and answer options assembled by code from the rule and the record.
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DOCUMENTATION QUERY (draft) Title: Clarification request: hematology documentation Encounter: ENC-00016 Patient: Orrin Treadwell To: Dr. Jalen Carrow Clinical indicators from the health record: - Documented in the record: "acute blood loss anemia" [Progress note DOC-000052] - sex F [encounter ENC-00016] - hemoglobin 11.21 g/dL (first) (2026-11-06 15:51) [lab LAB-000538] - hemoglobin 9.81 g/dL (lowest) (2026-11-08 05:00) [lab LAB-000540] Question: Could you review the hemoglobin values and treatment above and clarify any related diagnosis, if clinically appropriate? Response options (select one or write your own): ( ) Other (please specify): ____________ ( ) Unable to determine Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.
Other findings on this encounter
- Hyponatraemia · Specificity gap Criteria support Hyponatraemia (moderate) (E87.1); no corresponding diagnosis is documented.
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 1981 | 2026-11-14T20:57:23 | system:llm system |
llm.call |
ENC-00016, ENC-00016.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry 913a7cef1ba8 |
| 1155 | 2026-11-14T19:24:28 | system:llm system |
llm.call |
ENC-00016, ENC-00016.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry 75390796881e |
| 413 | 2026-11-14T18:29:03 | system:llm system |
llm.call |
ENC-00016, ENC-00016.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry fe47ffcd43bd |