Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

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Pilar Upfield: Acute blood loss anaemia

ENC-00055 · 73F · Hospital Medicine · admitted Wed Nov 11, 2026 08:30 AM · in hospital · attending Dr. Odette Galloway · resident Dr. Greta Kowalczyk

Clinical judgement required Clinical judgement required Open In hospital: concurrent review Resident note awaiting attending cosign

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): 377 GI hemorrhage with MCC → 377 GI hemorrhage with MCC
Relative weight: 1.8280 → 1.8280 (+0.0000)
Codes before: K92.2, N17.9, J96.01, D62, I10, E78.5
Codes after: K92.2, N17.9, J96.01, D62, I10, E78.5

All open gaps on this encounter together: MS-DRG 377 → 377 (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.

Evidence (each item cited to a source row or a quoted span)
Input	Value	Source
Sex	F	sex F · encounter ENC-00055
First haemoglobin this stay (g/dL)	10.82	hemoglobin 10.82 g/dL (first) · lab LAB-001861 · 2026-11-11 09:30
Lowest haemoglobin this stay (g/dL)	9.42	hemoglobin 9.42 g/dL (lowest) · lab LAB-001863 · 2026-11-13 05:00
Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir	1.4	hemoglobin 10.82 · lab LAB-001861 · 2026-11-11 09:30 hemoglobin 9.42 · lab LAB-001863 · 2026-11-13 05:00
Red cell units transfused	0	derived (no source row)
A bleeding source quoted from a note, or a bleeding principal diagnosis	True	“coffee-ground emesis” · History and physical DOC-000191, p. 1, line 5 · quoted span verified Show the quote in the note … ce: Hospital Medicine Attending: Dr. Odette Galloway History of present illness: 73-year-old woman admitted with upper GI bleed. Presented after two days of coffee-ground emesis; GI consulted for endoscopy. Past medical history: hypertension, hyperlipidemia. Review of systems otherwise negative. Exam: Lungs: increased work of breathing … principal diagnosis K92.2 · encounter ENC-00055

Rule trace (inputs, thresholds, outcome)

Rule trace (rule blood_loss_anemia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
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=9.42, 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=True	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=9.42	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 #2070); 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-00055   Patient: Pilar Upfield   To: Dr. Odette Galloway

Clinical indicators from the health record:
- Documented in the record: "acute blood loss anemia" [Progress note DOC-000192]
- sex F [encounter ENC-00055]
- hemoglobin 10.82 g/dL (first) (2026-11-11 09:30) [lab LAB-001861]
- hemoglobin 9.42 g/dL (lowest) (2026-11-13 05:00) [lab LAB-001863]
- "coffee-ground emesis" (2026-11-11 11:30) [History and physical DOC-000191, p. 1, line 5]

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

Acute kidney injury · Clinical validation gap Documented “AKI” (N17.9) but the criteria are not met: KDIGO creatinine and urine-output criteria not met.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2070	2026-11-14T20:57:23	system:llm system	`llm.call`	ENC-00055, ENC-00055.blood_loss_anemia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry aa9c4a057f65
1244	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00055, ENC-00055.blood_loss_anemia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry 29b795c91f27
502	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00055, ENC-00055.blood_loss_anemia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 06adcf12a30a output 69ee00077904 entry 5a5bca7bcc08