Extended criteria (experimental).
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← Back to the worklist · Whole encounter ENC-00177
Nico Merriweather: Acute blood loss anaemia
ENC-00177 · 50M · Cardiology · admitted Mon Nov 09, 2026 09:05 PM · in hospital · attending Dr. Jalen Carrow · resident Dr. Keira Upfield
Clinical validation gap Criteria met Open
In hospital: concurrent review Resident note awaiting attending cosign
Documented “acute blood loss anemia” (D62) is more specific than the criteria support (Anemia (acute blood-loss criteria not met), D64.9).
Documented vs supported
- Documented
- “acute blood loss anemia” · D62 Acute posthemorrhagic anemia
- Criteria support
- Anemia (acute blood-loss criteria not met) · D64.9 Anemia, unspecified
- Outcome
- Anaemia (nadir 11.1) without an acute fall or transfusion
- 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).
Effect if the clinician agrees (illustrative)
- Change
- D62 -> D64.9
- Secondary-diagnosis level
- CC → non-CC
- MS-DRG (illustrative)
- 291 Heart failure and shock with MCC → 291 Heart failure and shock with MCC
- Relative weight
- 1.2838 → 1.2838 (+0.0000)
- Codes before
- I50.23, E43, E87.1, D62, E78.5, K21.9
- Codes after
- I50.23, E43, E87.1, E78.5, K21.9, D64.9
All open gaps on this encounter together: MS-DRG 291 → 292 (RW -0.4348).
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
-0.5 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 | M |
sex M
|
| First haemoglobin this stay (g/dL) | 11.54 |
hemoglobin 11.54 g/dL (first)
|
| Lowest haemoglobin this stay (g/dL) | 11.14 |
hemoglobin 11.14 g/dL (lowest)
|
| Highest value before the nadir minus the nadir (g/dL) highest value before the nadir minus the nadir |
0.4 |
hemoglobin 11.54
hemoglobin 11.14
|
| 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=11.14, sex=M, 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=0.4, 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=0.4, prbc_units=0, t.drop_min=1.0 | true |
Documentation query
Title and question drafted by model clockworks-mock (audit entry #2302); 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-00177 Patient: Nico Merriweather To: Dr. Jalen Carrow Clinical indicators from the health record: - Documented in the record: "acute blood loss anemia" [Progress note DOC-000594] - sex M [encounter ENC-00177] - hemoglobin 11.54 g/dL (first) (2026-11-09 22:05) [lab LAB-006081] - hemoglobin 11.14 g/dL (lowest) (2026-11-10 05:00) [lab LAB-006082] Question: The indicators above are documented in this encounter. Could you clarify the status of the documented hematologic diagnosis? Response options (select one or write your own): ( ) Acute blood loss anemia: confirmed (please document the supporting clinical information) ( ) Acute blood loss anemia: ruled out ( ) Other explanation of the clinical findings (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 · Clinical validation gap Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).
- Malnutrition · Clinical validation gap Documented “severe malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).
History
| Seq | When (UTC) | Actor | Action | Entities | Decision / reason | Model / hashes |
|---|---|---|---|---|---|---|
| 2302 | 2026-11-14T20:57:26 | system:llm system |
llm.call |
ENC-00177, ENC-00177.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 87438843e589 output d57a2be09729 entry 251026bd4409 |
| 1476 | 2026-11-14T19:24:32 | system:llm system |
llm.call |
ENC-00177, ENC-00177.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 87438843e589 output d57a2be09729 entry c29f825db8e9 |
| 734 | 2026-11-14T18:29:07 | system:llm system |
llm.call |
ENC-00177, ENC-00177.blood_loss_anemia | — | clockworks-mock mock-1/exactdx.draft_query@1 prompt 87438843e589 output d57a2be09729 entry 76141267c5db |