Severe Anemia (1.4 g/dL) Due to Uterine Fibroid Bleeding With Reversible Myocardial Dysfunction: A Case Report

Abnormal uterine bleeding (AUB), particularly when associated with uterine leiomyomas, is a frequent cause of iron deficiency anemia among women of reproductive age. While commonly manageable, in rare instances, AUB can result in critically low hemoglobin levels, with potentially life-threatening consequences. We report a rare case of a patient presenting with a hemoglobin concentration of 1.4 g/dL secondary to fibroid-induced hemorrhage, complicated by acute but reversible myocardial dysfunction. We describe the case of a 41-year-old North African woman with a known history of uterine fibroids and endometriosis, who presented to the emergency department with profuse AUB and altered consciousness. On admission, she was hemodynamically unstable with severe anemia (hemoglobin 1.4 g/dL, hematocrit 5.1%), coagulopathy, and metabolic acidosis. Pelvic ultrasound revealed two fibroids, one submucosal and one pedunculated. The patient received aggressive resuscitation, including transfusion of 6 units of packed red blood cells and 5 units of fresh frozen plasma intraoperatively with norepinephrine support (0.3-0.8 µg/kg/min), followed by total hysterectomy. Postoperatively, she developed respiratory distress diagnosed as cardiogenic pulmonary edema with acute left ventricular systolic dysfunction (ejection fraction 28%), definitively distinguishing it from Acute Respiratory Distress Syndrome (ARDS) and Transfusion-Related Acute Lung Injury (TRALI) based on echocardiographic findings, clinical presentation, and rapid response to diuretic therapy. Medical management led to gradual improvement, and one month later, her ejection fraction normalized to 50%. This case clearly illustrates the remarkable ability of the human body to adapt under extreme hematological stress caused by uterine fibroid-related hemorrhage. Serial echocardiographic documentation demonstrates complete reversibility of anemia-induced cardiomyopathy. It also demonstrates how timely diagnosis and coordinated medical intervention can effectively prevent severe complications, including permanent myocardial damage. While 23 published cases with hemoglobin <2 g/dL exist in medical literature, only three cases at the 1.4-1.6 g/dL level have been documented, underscoring this case's extreme rarity and educational value.