Department of Medicine, University of Southern California, Los Angeles, CA, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA.
J Med Case Rep. 2021 Sep 13;15(1):472. doi: 10.1186/s13256-021-03024-9.
Anemia is a serious global health problem that affects individuals of all ages but particularly women of reproductive age. Iron deficiency anemia is one of the most common causes of anemia seen in women, with menstruation being one of the leading causes. Excessive, prolonged, and irregular uterine bleeding, also known as menometrorrhagia, can lead to severe anemia. In this case report, we present a case of a premenopausal woman with menometrorrhagia leading to severe iron deficiency anemia with record low hemoglobin.
A 42-year-old Hispanic woman with no known past medical history presented with a chief complaint of increasing fatigue and dizziness for 2 weeks. Initial vitals revealed temperature of 36.1 °C, blood pressure 107/47 mmHg, heart rate 87 beats/minute, respiratory rate 17 breaths/minute, and oxygen saturation 100% on room air. She was fully alert and oriented without any neurological deficits. Physical examination was otherwise notable for findings typical of anemia, including: marked pallor with pale mucous membranes and conjunctiva, a systolic flow murmur, and koilonychia of her fingernails. Her initial laboratory results showed a critically low hemoglobin of 1.4 g/dL and severe iron deficiency. After further diagnostic workup, her profound anemia was likely attributed to a long history of menometrorrhagia, and her remarkably stable presentation was due to impressive, years-long compensation. Over the course of her hospital stay, she received blood transfusions and intravenous iron repletion. Her symptoms of fatigue and dizziness resolved by the end of her hospital course, and she returned to her baseline ambulatory and activity level upon discharge.
Critically low hemoglobin levels are typically associated with significant symptoms, physical examination findings, and hemodynamic instability. To our knowledge, this is the lowest recorded hemoglobin in a hemodynamically stable patient not requiring cardiac or supplemental oxygen support.
贫血是一个严重的全球健康问题，影响所有年龄段的人，但特别是育龄期妇女。缺铁性贫血是女性中最常见的贫血原因之一，月经是主要原因之一。月经过多、持续时间长和不规律的子宫出血，也称为功能性子宫出血，可导致严重贫血。在本病例报告中，我们介绍了一位育龄期妇女因功能性子宫出血导致严重缺铁性贫血和记录到的极低血红蛋白水平的病例。
一位 42 岁的西班牙裔妇女，无已知既往病史，主要抱怨疲劳和头晕加剧 2 周。初始生命体征显示体温 36.1°C，血压 107/47mmHg，心率 87 次/分钟，呼吸频率 17 次/分钟，在室内空气下血氧饱和度为 100%。她完全警觉，定向力正常，无神经功能缺损。体检还发现典型的贫血表现，包括：明显苍白、黏膜和结膜苍白、收缩期血流杂音和指甲凹陷。她的初始实验室结果显示血红蛋白严重缺乏，仅为 1.4g/dL，严重缺铁。进一步的诊断检查后，她的严重贫血可能归因于长期的功能性子宫出血，她表现得非常稳定，可能是因为多年来的显著代偿。在住院期间，她接受了输血和静脉铁补充治疗。她的疲劳和头晕症状在住院期间得到缓解，出院时恢复了正常的日常活动水平。
血红蛋白水平极低通常与严重的症状、体检发现和血液动力学不稳定相关。据我们所知，这是在不需要心脏或补充氧气支持的情况下，血液动力学稳定的患者记录到的最低血红蛋白水平。
