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Preparing patient data...
🔐 Physical Puzzle Required
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LOCKED
Solve the physical puzzle to unlock
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🚨 ALERT

Discover the Enemies

Preoperative Anaemia Escape Room

🌐 World Congress of Anaesthesia 2026

A patient is scheduled for major surgery in the next 48 hours.
Hidden threats lurk in the lab results. You must unlock the diagnostic boxes, identify the preoperative anaemia, determine its underlying cause, and classify it before time runs out.

The patient's outcome depends on you.

📋 BRIEFING

Mission Rules

Read carefully before entering the field

  • ⏱️ Speed matters! Answer faster to earn time bonuses — up to +50 extra points per correct answer.
  • ✅ Correct answers unlock lab results and earn +100 points per box, +60 points per match, and +200 points for the final diagnosis.
  • ❌ Wrong answers cost you! Each mistake applies a permanent penalty — you lose points and cannot recover them, even if you answer correctly later.
  • 💡 Hints are available but each hint used will reduce your score by −10 points.
  • 🔒 3 Phases: Unlock lab boxes → Match values to parameters → Classify the anaemia. Complete all three to save the patient!
PHASE 1 / 3

🏥 PATIENT FILE — CLASSIFIED

Patient ID
#ER-2026-0417
Age / Sex
67 y/o Male
Scheduled Surgery
Total Hip Replacement
ASA Class
III
Comorbidities
HTN, CKD Stage 2, T2DM
Medications
Metformin, Lisinopril, Aspirin

📊 VITAL SIGNS

138/82
BP mmHg
78
HR bpm
96%
SpO₂
36.7°C
Temp
72 kg
Weight

🔒 LOCKED LAB RESULT BOXES

Solve each puzzle to unlock the patient's lab results. Identify the enemies hiding among the data.

🔒
BOX A
Complete Blood Count
LOCKED
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BOX B
Iron Studies
LOCKED
🔒
BOX C
Additional Markers
LOCKED
PHASE 2 / 3

🧩 MATCH LAB VALUES TO CLINICAL SIGNIFICANCE

Each lab value has a specific clinical meaning in the context of perioperative anaemia and PBM. Match each result to its correct clinical interpretation.

📋 Lab Results

Hb 9.2 g/dL
Ferritin 300 ng/mL
TSAT 12%
CRP 28 mg/L
MCV 74 fL
Total Iron-Binding Capacity 410 µg/dL
Reticulocytes 0.8%
RDW 18.2%

🏷️ Clinical Significance

Preoperative anaemia (WHO male threshold)
Acute-phase reactant — falsely elevated by inflammation
Inadequate iron delivery to erythroid marrow
Active inflammation → hepcidin upregulation
Microcytosis — iron-restricted erythropoiesis
Compensatory transferrin increase (liver response)
Inadequate marrow erythropoietic response
Anisocytosis — mixed cell populations
Think about what each abnormal value tells you pathophysiologically: which reflects inflammatory confounding vs. delivery failure vs. production inadequacy vs. iron demand? Total Iron-Binding Capacity rises when the body tries to capture more iron. Ferritin is falsely elevated by inflammation (acute-phase reactant). RDW widens when old and new RBC populations coexist.
PHASE 3 / 3

🎯 CLASSIFY THE ANAEMIA

Based on the lab results you've uncovered, select the correct diagnosis for this patient's anaemia.

🩸
Absolute Iron-Deficiency Anaemia (without inflammatory component)
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Anaemia of Chronic Disease (functional iron deficiency only)
⚠️
Mixed-Deficiency Anaemia: Absolute Iron Deficiency + Inflammatory Component
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Functional Iron Deficiency with EPO Resistance (CKD-related)
💧
Dilutional Anaemia secondary to fluid overload
🫘
Renal Anaemia (EPO-deficient) with secondary iron sequestration
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Low-grade Haemolytic Anaemia (aspirin-induced)
💊
Combined Nutritional Deficiency (Iron + B12/Folate)
Hb 9.2 g/dL (low) + Ferritin 300 ng/mL (falsely elevated by inflammation) + TSAT 12% (low) + CRP 28 mg/L (elevated) = iron deficiency masked by inflammation.
MCV 74 fL (low) = microcytic picture.
The discordance between elevated ferritin and low TSAT/elevated Total Iron-Binding Capacity, in the context of raised CRP, points to a mixed picture: iron deficiency + inflammatory component.
🏆

MISSION COMPLETE

You Successfully Identified the Enemies!

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🔑 KEY TAKEAWAY

Early detection and treatment of preoperative anaemia — including mixed-deficiency states — significantly improves surgical outcomes, reduces transfusion requirements, shortens hospital stays, and decreases perioperative morbidity and mortality.

Screen early. Diagnose accurately. Treat promptly.
🖥 FACILITATOR